If you are a provider that accepts Aetna members in your office? Then this blog post is for you!

For any DOS 11/1/26 and there after Aetna will reimburse only quantity 1 for SGRT whole course of treatment – no matter how many treatment sessions were done.

The affected plans:

• Aetna Commercial
• Aetna Medicare

What does your office need to know?

• Bill code 77436 with a quantity of 1
• Claims submitted with multiple units will be denied or adjusted as per reimbursement policy
• This policy aligns with CMS policy- the code is allowed to be billed ONE time per course of treatment
• Remindet: the code 77436 is NOT allowed to be billed with the following codes- 77261–77262 or simulation code 77280.

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