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Aetna Clinical Payment, Coding and Policy Changes

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Aetna regularly adjusts its clinical, payment and coding policy positions as part of its ongoing policy review processes. This chart outlines coding and policy changes with June, 2011, effective dates.

Procedure Change
Supplies for maintenance of drug infusion catheter, per week (A4221) Aetna will pay A4221 once per week based on HCPCS coding guidelines; however, for physicians, it is considered incidental and not separately payable.
Visual evoked potentials (VEPs) -- Clinical Policy Bulletin (CPB) 181 Visual Evoked Potentials (VEP) are considered conditionally eligible for specific diagnoses outlined in Clinical Policy Bulletin. All other indications are considered experimental and investigational including routine screening.
PCR amplified probe (CPB) 650 Infectious agent quantification using nucleic acid (DNA or RNA) technique is conditionally eligible for specific diagnoses outlined in Clinical Policy Bulletin #0650 -- Polymerase Chain Reaction Testing. All other indications are considered experimental and investigational.
Cervical Cancer screening and diagnosis -- CPB 443 HPV testing is considered experimental and investigational for girls and women less than 21 years of age based on the recommendations of the American College of Obstetricians and Gynecologists.
Vascular catheters (A4305/A4306) Vascular catheters used in conjunction with a medical and/or surgical procedure will be considered incidental to the primary procedure.
Modifier 52 -- Reduced Services Modifier 52 is reported when a service or procedure has been partially reduced or eliminated at the physician’s discretion. Aetna pays 50 percent of either the negotiated rate or recognized charge without review for a procedure billed with Modifier 52.
ADA exam/evaluation codes billed with anesthesia ADA exam/evaluation codes (D0120, D0140, D0150, D0160, D0170, or D0180) will be denied when billed with anesthesia codes (D9220, D9221, D9241, D9242, or 00170).
Anesthesia for intraoral procedures, including biopsy (not otherwise specified) ASA code 00170 will be allowed when billed with intraoral surgery procedure codes.
Cast supplies billed with orthopedic shoes A4580 will deny as incidental when billed with a code within range L3000 - L3090. Modifier 59 will not override these edits.
Removal of neurostimulator arrays 63661 will deny when billed within 90 days of procedure code 63650.
Multiple Procedure Reductions for CT scans, MRIs and Ultrasounds

Effective June 1, 2011, our policy for multiple imaging procedures will change to apply the reduction when two or more services are furnished to the same patient in a single session. This change is based on the CMS Policy change that went into effect on January 1, 2011. CMS consolidated the 11 imaging families into one family. Our current policy applies the reduction to scans performed on contiguous body areas based on the 11 imaging families. As of June 1, 2011, the reduction will be based on one imaging family.