Category: Payers and CPT reinbursement

Posted in #unitedhealthcare, Payers and CPT reinbursement, Pharmacy (Various Insurance Payers)

UHC Medicaid: Idaho: diabetic DME coverage change-benefit

Posted on by KR2Medical Billing

Starting for DOS 4/1/26 and thereafter the following codes will be covered through the patient pharmacy benefit and no longer will be covered under patient medical benefit.

Images via UHC website

For DOS 1/1/26 through 3/1/26- providers can still bill either through medical benefit or pharmacy benefit.

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

Are you leaving revenue on the table?

Posted on by KR2Medical Billing

Aetna update!

Is your practice compliant?

Are you appending proper modifiers to radiology, diagnostic services and surgery services- when billed with the following ICD-10 codes: Z53.01, Z53.09, Z53.1, Z53.20, Z53.21, Z53.29, Z53.8, Z53.9?

As per Aetna- if the following modifiers are not billed on the claims for the above services with above named ICD-10 codes- the claims will be denied.

This change will take affect April 1,2026 and apply to commercial and Medicare plans.

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

Aetna: reimbursement update ventral hernia

Posted on by KR2Medical Billing

This change will apply to the dates of service on 4/1/26 and thereafter.

The plans that ate affected are commercial and Medicare.

Bundled payments:

The following codes will no longer be reimbursed separately-15374 and 49649, when billed with the following codes: venrtal hernia

Less than 3 cm- 49591 to 49594 and 49613 to 49616

3cm  to 10 cm- same codes.

For Washington members/plans-fpr commercial plans- the effective date will be given following a regulatory review.

For Texas- for fully ensured plans- this will be only if such changes comply with regulatory requirenments. For all other plan types are affected by this change

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