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Aetna Clinical Payment, Coding and Policy Changes

Recent News


Procedure Effective Date Change

Clinical Policy Bulletin #0530 – Transvaginal Ultrasonography for Ovarian and Endometrial Cancer Screening and Other Selected Indications

 3/1/2012 Clinical Policy Bulletin #0530 is being revised to state that transvaginal ultrasonography (CPT 76830) is considered experimental and investigational for confirmation of placement of an intra-uterine device following insertion.

A9279 – Monitoring feature/device, stand-alone or integrated, any type, includes all accessories, components and electronics, not otherwise classified

 3/1/2012 A9279 will be considered incidental to all monitoring systems. Separate reimbursement will not be allowed.

Orthotic and prosthetic equipment/supplies – L2780, L2840, L5685

 3/1/2012

Per day limits will apply to the following codes, effective 3/1/2012:
L2780, L2840 and L5685 will be allowed 6 times per date of service.

Orthotic and prosthetic devices

 3/1/2012

Additional components or features for prefabricated or custom knee orthoses will be denied. Modifier 59 will not override these edits.

92586 – Auditory evoked potentials for evoked response audiometry and/or testing of the central nervous system; limited

 3/1/2012 Newborn hearing screening that is billed to a provider other than a contracted inpatient facility will be denied as incidental. This service is included in the facility’s case rate and will not be paid separately.
Bilateral noninvasive physiologic studies of upper or lower extremity arteries Delayed

The following policy change was communicated as having a 9/1/2011 implementation date. This policy change has been delayed until further notice:
Procedure codes 93922 and 93923 will be considered incidental when billed with either G0166 (external counterpulsation) or 92971 (Cardioassist).