For Healthcare Providers:

News Archives

Aetna Clinical Payment, Coding and Policy Changes

9/25/2012

Procedure	Effective Date	Change
Pelvic and transvaginal ultrasounds	12/1/2012	76856 will deny as incidental when billed with 76830 on facility claims. Specialist claims are currently subject to this edit.
Evaluation and management codes billed by certain non-physician provider types	12/1/2012	Evaluation and management codes will not be allowed for the following specialists: - Audiologists - Dieticians - Nutritionists - Physical, occupational and speech therapists
Gastric band adjustments	12/1/2012	S2083 will deny as incidental when billed within the 90 day global period of codes 43770, 43771, and 43773.
Breast reconstruction	12/1/2012	S2068 will deny as mutually exclusive to 19364 when billed on the same date of service. Modifier 59 will not override this edit.
Per day limits	12/1/2012	The following per day limits will apply: - 88329 – 4 units per date of service - 85097 – 2 units per date of service - L2810 – 4 units per date of service, 2 times per side - L6682 – 4 units per date of service, 2 times per side - 88346 – 10 units per date of service
Endometrial ablation	12/1/2012	Aetna will require that members having endometrial ablation procedures also have evidence of endometrial sampling performed within one year prior to the endometrial ablation procedure. Endometrial sampling codes are 58100, 58110, 58120 and 58558. Refer to Clinical Policy Bulletin #0091 – Endometrial Ablation.
Bilateral noninvasive physiologic studies of upper or lower extremity arteries	12/1/2012	Procedure codes 93922 and 93923 will be considered incidental when billed with either G0166 (external counterpulstation) or 92971 (Cardioassist). Aetna is delaying this policy from September 1, 2011 to December 1, 2012.
Allograft and autograft for spinal surgery only – codes 20930 and 20936	Reminder: Effective 10/1/2012	Codes 20930 and 20936 will be disallowed when billed with another CPT and/or HCPCS procedure code. Modifier 59 will not override these edits.
The following procedure codes will no longer be considered diagnostic in nature, but as surgical services. As a result of this change, claims for these procedures may begin to be reimbursed at the contractual surgical rate, instead of the diagnostic rate.	1/1/2013	Codes affected are: 59012, 59015, 91000, 91010, 91011, 91012, 91020, 91022, 91030, 91034, 91035, 91037, 91038, 91040, 91052, 91055, 91060, 91100, 91105, 91120, 91122, 92502, 92511, 92970, 92975, 92986, 92987, 92990, 92992, 93312, 93313, 93314, 93315, 93316, 93317, 93318, 93615, 93616, 93740, 95830, 51725, 51726, 51772, 51785, 51795, 51797
The following procedure codes will no longer be considered contrast/image enhancing agents in nature. As a result of this change, claims for these procedures may begin to be considered.	1/1/2013	A9517, A9530, A9543, A9545, A9563, A9564, A9600, A9699
The following procedure codes will be considered contrast/image enhancing agents in nature. As a result of this change, claims for these procedures may begin to be reimbursed or denied.	1/1/2013	A9581, A9582, A9583