Aetna Payment Updates

Aetna has reached agreement with various state medical societies to provide reimbursement for add-on CPT codes. Under the agreement, Aetna will pay for add-on codes retroactive to the date that the codes became effective under CPT. The agreement states that “add-on codes, as designated by CPT, shall be recognized and eligible for payment as separate codes and shall not be subject to Multiple Procedure Logic.”

Providers may resubmit previously denied claims to Aetna for payment. Additional information about payment for add-on codes is available on Aetna’s Web site at www.aetna.com/provider/addon_claims_payment.html.

Aetna has also advised that, as a result of the lawsuit settlement announced on May 21, 2003, two changes will be made in its payment policy for Evaluation and Management (E/M) codes that became effective on February 6, 2006. One, Aetna will provide reimbursement when two E/M codes are billed on the same day, provided that the services are medically necessary. Two, Aetna will allow modifier -57 to be appended to an E/M code when billed with a major procedure. Providers who received payment denials within 180 days prior to February 6, 2006, may resubmit the denied claims along with a cover letter requesting a rework for E/M codes.

Physicians may contact Aetna’s Provider Service Centers at (888) 632-3862 (indemnity or PPO plans) or (800) 624-0756 (HMO plans) for additional information about payment policies.