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Aetna Clinical Payment, Coding and Policy Changes

Recent News


Procedure Effective Date Change
Emergency Room – Level of Care 3/1/2011 This policy has been updated to only apply when a facility bills CPT codes 99285 and 99284.
Precertification will not override incidental procedure denial 9/1/2011 Precertifications will not override related services that are considered incidental.
Chiropractic treatments (98940-98943) 9/1/2011 Chiropractic treatments are conditionally eligible for neuromusculoskeletal disorders as outlined in Clinical Policy Bulletin #0107 – Chiropractic Services. All other indications are considered experimental and investigational.
Prolonged physician services 9/1/2011 Aetna does not pay for medical services without direct patient contact; thus, procedure codes 99358 and 99359 will be denied.
Intra-operative electromyographic monitoring 9/1/2011 Procedure codes 95867 and 95868 (needle electromyography, cranial nerve supplied muscles, unilateral/bilateral) will be denied as experimental/investigational when billed with 60000-60512.
Epstein-Barr Viral Capsid Antigen (VCA) Antibody (IgA) 9/1/2011 Procedure code 86665 will be allowed three (3) times per date of service.
Emergency room facility claims 9/1/2011 Aetna clinical and payment policies apply to emergency room facility claims.
OB codes billed with Modifier 59 – 59510 and 59515 9/1/2011 Modifier 59 will no longer override the denial of CPT codes 59510 and 59515 when billed together.
Related services Reminder Services related to an ineligible procedure or service will be denied.
Intervertebral disc prostheses Reminder The use of hybrid fusion with artificial disc replacement is considered experimental and investigational.
Bilateral noninvasive physiologic studies of upper or lower extremity arteries 9/1/2011 Procedure codes 93922 and 93923 will be considered incidental when billed with either G0166 (external counterpulsation) or 92971 (Cardioassist).
Multiple procedure reductions for therapy procedures 11/14/2011 The procedure with the highest RVU will be allowed at 100 percent. Additional therapy services performed by the same provider on the same date of service will be allowed at 80 percent.