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 Cinga Insurance, Payer Updates, Training

Cinga updates some Preventative care Services

Changes/Updates are effective 01-01-2023


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Posted in Training, Updates

UHC Oxford- updated Prior Auth changes 01/01/2023

Starting 01/01/2023 Oxford will add and remove certain codes that require prior authorizations (commercial line of business).

According the Oxford this change helps align their processes with evidence-based clinical guidelines.


Some of the new codes that will be added are:

For a full list of new codes that will be added to the list of codes that require prior authorization, please click here.


In addition Oxford is also adding a new provider tool, the UnitedHealthcare Oxford plan Prior Authorization Requirements document, it will become available as of Dec. 1, 2022, on the Advance Notification and Clinical Submission Requirements page.

Providers are encouraged to use this tool where they will be able to find/research codes that require prior authorization as well as request an auth.


Would you like to learn more: please click here, for the Applicable Oxford Commercial policies.


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#medicalcoding, #medicalbilling, #priorauthorization, #cardiology, #uhc, #oxford