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.
According to Aetna June 2022 provider newsletter- Aetna will NO Longer pay for the mid level staff: nurse practitioners, physician assistants, certified nurse midwives and clinical nurse specialists, at 100%, if they are performing the following codes:
G0402- Long description: Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment Short description: Initial preventive exam
G0438- Long description: Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit
Short description: Ppps, initial visit
G0439- Long description: Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit
Short description: Ppps, subseq visit
Note to Washington State providers: Your effective date for changes described in this article will be communicated following regulatory review.
KR2 Medical Billing 