Aetna: usage of modifier CT and reimbursement

If you are a provider that accepts Aetna Commercial and Medicare Plans? Then this blog post is for you!

For any DOS 9/1/2026 and thereafter Aetna, once the provider bills the modifier CT, will apply a 15% payment reduction will be applied to certain radiology services.

Definition: CT modifier is used to represent that CT (computed tomography) technology used does not meet the National Electrical Manufacturers Association (NEMA) XR 29-2013 “Smart Dose”
standards.

The reduction will apply to the following:

The technical component (TC) of the service

  • The TC portion of global billing
  • Computed tomography (CT) imaging services
  • Both the Medicare Physician Fee Schedule (MPFS) and the Outpatient Prospective
    Payment System (OPPS

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