For Healthcare Providers

Arthroscopy

Modifier 59 will no longer override these codes as 29875 is considered integral to the successful completion of 29877 and 29881.

Cytogenetics

88291 is currently mutually exclusive when billed with codes 82013, 82106, 83890-83892, 83894-83898, 83901-83906, 83912, 84443, 85300-85306, 85730, 86701-86703, and 88182-88189. Effective with this change, Modifier 59 will not override these codes if these lab tests are not part of the cytogenetics studies.

For procedures eligible to be billed with a component modifier, Aetna will allow payment for one professional and one technical component of a laboratory or diagnostic test. Additional professional interpretations or technical components by the same or different provider are considered duplicative, and are not eligible for separate reimbursement unless it is a repeat test/ procedure.

Chemotherapy administration and non-chemotherapy drug infusion

Modifier 25 will no longer override the denial of CPT code 99211 when billed with a chemotherapy administration code or non chemotherapy drug infusion code. 

39502, 39520, 43280, 43324, 43499, and 43659 will deny as incidental when billed with obesity surgery code ranges 43770-43774 and 43842-43848. Modifier 59 will not override these codes as hiatal hernia repair (39502, 39520, 43280, 43324, 43499, and 43659) is considered an integral part of obesity surgery.

Problem-focused E&M and E&M consultation codes will not be allowed when billed with codes 92506, 97001, 97002, 97003, 97004, or 92610, unless Modifier 25 or 59 is appended to the claim.