If you are a provider that accepts Aetna members with commercial and Medicare plan types, in your practice, then this blog post is for you!
Are you checking your MUE and PTP edits, to make sure your office recieves proper reimbursement?
This update affects procedures that are performed on or after DOS 7/1/26.
What is changing?
- Procedures: 15733–15738 — Reconstructive flaps (muscle, myocutaneous orfasciocutaneous) 14000–14302 —Adjacent tissue transfer or rearrangement billed with primary procedure codes listed below will be bundled into the payment of the primary procedure and will not receive a separate reimbursement
Primary procedure codes:
- 19300–19396 — Breast surgery procedures 40490–49999 — Digestive system surgery procedures
As per Aetna- any procedure that is listed above that includes closures and are performed by another provider/surgeon that is not the one that performs the primary procedure should not be billed separately
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