Posted in #aetna, #Medicare, #Medicareadvantage

Aetna Reimbursement Policy: Radiology Modifiers

According to provider October updates: Aetna will reduce the reimbursement rate for HCPCS radiology codes when modifiers FX and FY are appended.

Modifier FX: the reimbursement rate will be reduced by 20% for the technical component and the (technical component of a global fee) Definition: x-ray images taken by using film

Modifier FY: the reimbursement rate will be reduced by 10% for the technical component and the (technical component of the global fee) Definition: computed radiography X-ray)

Effective for any DOS on or after 1/1/2024.

Type of plans affected: commercial and Medicare lines of business plan types.

Posted in #aetna, #Medicare, #Medicareadvantage, Payer Updates, Payers and CPT reinbursement, Training, Updates

Aetna Reimbursement Policy: A9275

According to the Aetna October Provider Updates: Aetna will NO LONGER REIMBURSE for code A9275- Home glucose disposable monitor, includes strips. This DME is considered statutory non-covered by Medicare.

Effective Date: 1/1/2024

This reimbursement policy change applies to commercial and Medicare lines of business (plan types).

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Posted in #aetna, #Medicare, #Medicareadvantage, Payers and CPT reinbursement

Aetna Commercial and Medicare Plans: Payment for Occupational Therapy/Physical Therapy Assistants

As per Aetna Updates: starting December 1,2023 the Occupational Therapy Assistants and Physical Therapy Assistants will get their own reimbursement for performed services.

Reimbursement amount: 85% of Allowed amount.

Please append the following modifiers to the services that are performed by the PTAs and OTAs:

CO-occupational therapy services performed in part or as a whole by an Occupational Therapy Assistant

CQ-physical therapy services performed in part or as a whole by a Physical Therapy Assistant.

This change applies to Medicare and Commercial plan types.

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Anthem BCBS NY: New PET tracer UM policy

The following information will apply to any DOS on 12/1/25 and thereafter. Starting 12/1/25 the PET tracer will require an auth in addition to PET services. Please submit both PET and radiotracer codes- for prior authorization. The UM criteria for PET will not be affected. However both codes will be either approved or denied. Please…

PrEP proper billing and coding

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