Tag: #aetna

Find any medical billing and coding guidelines that relates to Aetna Insurance Payer. Includes multiple states

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

AETNA Commercial Plans: compression supplies non covered codes.

Posted on by KR2Medical Billing

Please note that this policy update applies to the members that have commercial plan types.

The affected codes: for any DOS on or after Jan 1st 2026, Aetna will consider the following codes for compression stockings to be a disposable supply and a standard benefit exclusion.

Codes:

For Texas Providers:

These changes apply to fully insured plans written in Texas and only if such changes are in accordance with applicable regulatory requirements. Changes for all other plans will be as outlined in this article.

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Posted in #aetna, #Medicareadvantage, #reimbursement, NY Providers, Prior Authorization Insurance Carrier Updates, Training

Aetna Medicare Advantage: reminder- certain post acute, skilled nursing and home health require pre- approval

Posted on by KR2Medical Billing

This change applies to the providers located in the following states:

NJ, NY, PA, VW

The pre-apporoval applies to some post-acute , skilled nursing, and home health services.

The following HCPCS are affected:

  • G0151: Services performed by a qualified physical therapist in the home health or hospice setting, each 15 minutes.
  • G0153: Services performed by a qualified speech-language pathologist in the home health or hospice setting, each 15 minutes.
  • G0155: Services of a clinical social worker in home health or hospice settings, each 15 minutes. 
  • All the codes until G0162

As well as the following codes:

G0299- Direct skilled nursing services of a Registered Nurse (RN) in the home health or hospice setting, each 15 minutes.

G0300-Direct skilled nursing services of a Licensed Practical Nurse (LPN) in the home health or hospice setting, each 15 minutes.

G0463- Skilled services by a Registered Nurse (RN) for observing and assessing a patient’s condition.

G0496- Skilled services by a Licensed Practical Nurse (LPN) for training or educating a patient or family member.

Inpatient Revenue code:

128- daily medical management, skilled rehab services, and regular physician (MD/NP/PA) oversight for intensive rehab patients

Skilled Nursing levels: 1,2,3,4.

Pre-auth process:

1. Go to EviCore.

2.Call 1-888-622-7329 during normal business hours.

3.Fax a request form to 866-705-3574 (Aetna Home Health), 855-633-8631 (AETNA PAC Initial) or 877- 502-0810 (AETNA PAC Concurrent)

For any urgent requess, when  member requires services in less than 48 hours, please call eviCore.

Find this information useful? Follow my blog for more information about current medical billing, coding and reimbursement policies.

Posted in #aetna, #Medicareadvantage, #reimbursement, Training, Updates

Aetna: Reimbursement for evaluations with G2082 and G2083 codes…

Posted on by KR2Medical Billing

According to Aetna, effective for DOS 3/1/24 and thereafter, evaluation codes 99212-99215, 99415–99417 will no longer be reimbursed separately when billed on the same DOS for the same member by the same provider.

This change will apply to Commercial and Medicare Advantage Plans.

Modifier 25 will not be able to override this claim edit and the payment for the E/M codes will be included in either code G2082 or G2083

G2082-temporary code for 2024- office or outpatient visit for evaluation and management of already established patient that requires physician or other qualified health care professional supervision up to 56 mg of esketamine nasal self- administration, includes 2 hours post-administration observation.

G2083-temporary code for 2024- office or outpatient visit for evaluation and management of already established patient that requires physician or other qualified health care professional supervision greater than 56 mg of esketamine nasal self- administration, includes 2 hours post-administration observation.

CTP codes 99415, 99416 are used to report the total amount of face-to-face time spent with the patient and/or family/caregiver by clinical staff in the office or
other outpatient setting, on a given date of service even if the time is not continuous. The
physician or qualified health care professional is present to provide direct supervision of the
clinical staff. Codes 99415, 99416 should not be used for prolonged services of less than 30
minutes total duration on a given date.

Want to stay current with the up-to date medical billing and coding information? Follow my blog. #medialbilling #medicalcoding #reimbursement

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