Posted in #aetna, #Medicare, #Medicareadvantage, Training, Updates

Aetna and Mid Level Reimbursement EM Services update 2022

According to Aetna June 2022 provider newsletter- Aetna will NO Longer pay for the mid level staff: nurse practitioners, physician assistants, certified nurse midwives and clinical nurse specialists, at 100%, if they are performing the following codes:


G0402-
Long description:
Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment
Short description: Initial preventive exam

G0438- Long description: Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit

Short description: Ppps, initial visit

G0439- Long description: Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit

Short description: Ppps, subseq visit


Note to Washington State providers: Your effective date for changes described in this article will be communicated following regulatory review.


How can you access the full policy?

Log in to Availity*** and follow these steps:

  1. Click on Payer Spaces > Aetna.
  2. In the search box, type “mid-level practitioners” and click Search.
  3. Choose “Mid-level Practitioners and Other Qualified Health Care Professionals — Resource.”

This policy applies to Aetna commercial and Medicare members.

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Author:

My name is Kate Patskovska, CPB. I am an Independent Medical Biller CPB (AAPC), AAPV Approved Instructor; and an owner of KR2 Medical Billing. I create educational material including blogs, presentations that focus on topics of medical billing, medical coding and reimbursement in healthcare.

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