Tag: #medicalcoding

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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Posted in #reimbursement, HealthFirst, NY Providers, Payer Updates, Payers and CPT reinbursement, Training

HealthFirst Telehealth mental health modifier update

Posted on by KR2Medical Billing

This update applies to HealthFirst following plan types: Medicaid, Personal Wellness Plan (HARP), and Medicaid Advantage.

Which services are affected?

Telehealth services done through a NY OMH licensed and or designated outpatient program.

Please refer to OMH modifier and rate code chart here.

Image via NYS OMH

To ensure the providers receive proper reimbursement, please make sure you go over payment rate changes and use the proper modifiers:

Modifier FQ- used for outpatient telehealth services, audio-only, for dual enrolled members.

Modofier 93- OMH providers – use this modifier for qualifying telehealth and audio-only mental health services, for members that are only enrolled in Medicaid.

The changes apply to the services performed on or after July 1st 2025.

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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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