According to Aetna, the participating wig providers (cranial prostheses) will see an increase in the reimbursement to $1,000. This change became effective 10/01/2018.
This change also applies to the providers located in Washington and Texas.
The providers have to be participating with Aetna
HCPCS code A9282
Last week I had a conversation with one of employees that works in the OBGYN office.
She said: ” Kate, I have a very large pile of denials on my desk. They all have to do with Vitamin D testing/screening for my Aetna patients. In the previous years, our office had no problem with testing women for Vitamin D. Now I have no idea what is going on? Is there anyway you can help me out?”
I said: “Sure, let me look in to it and I will let you know by tomorrow.”
Later that day I find out the following:
According to Aetna the Vitamin D assay testing is considered to be experimental and investigational for routine preventative screenings.
The next day I tell that employee what I found out.
She says: ” Wow. None of the people in my billing department had any answer for me! Thank you very much. I will pass this information on to both my clinical staff and my billing department. You are a big help!”
Do you see NY Empire State Plan patients? Have you noticed something different in your payments for the year 2019?
If not, then do not fret. Here is what is new for the year 2019
In 2019- reimbursement for CPT code 94200 is $0 with a patient responsibility of a co-pay of $25.
Yes, now the patient has to pay for the whole “allowed amount”!
Also the co-pay for the E/M codes also went up to $25 for certain plans. You will need to look up the benefits before the appointment.
Compare to 2018- reimbursement for CPT code 94200 was $5 with a co-pay of $20.
KR2 Medical Billing 