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 #aetna, #Medicare, #Medicareadvantage, Payers and CPT reinbursement

Aetna Commercial and Medicare Plans: Payment for Occupational Therapy/Physical Therapy Assistants

As per Aetna Updates: starting December 1,2023 the Occupational Therapy Assistants and Physical Therapy Assistants will get their own reimbursement for performed services.

Reimbursement amount: 85% of Allowed amount.

Please append the following modifiers to the services that are performed by the PTAs and OTAs:

CO-occupational therapy services performed in part or as a whole by an Occupational Therapy Assistant

CQ-physical therapy services performed in part or as a whole by a Physical Therapy Assistant.

This change applies to Medicare and Commercial plan types.

Find this type of content useful? Follow my blog for more medical billing and coding updates/changes from various insurance payers.

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Tufts Health One Care: New Plan name and ID cards

Does your provider accept Tufts Health One Care insurance? Then this blog post is for you- don’t leave money on the table and waste precious administrative time! As of Jan 1,2026- Tufts Health One Care became Tufts D-SNP – with such change members will receive new ID cards and member numbers. New ID cards: Authorizations…

Fidelis MMC: healthy nutrition benefit

Fidelis (NY) has partnered up with Foodsmart vendor to offer the Managed Medicaid Members nutrition services- “fully covered by the plan”. The services include a personalized telenutrition from registered nutritionist. Foodsmart services include: For more information, providers should contact: Paula West, Director of Provider Relations, at Paula.West@foodsmart.com. Ready to refer a member? Find this information…

UHC Medicaid: Idaho: diabetic DME coverage change-benefit

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. For DOS 1/1/26 through 3/1/26- providers can still bill either through medical benefit or pharmacy benefit. Find this type of content useful? Follow my blog!

Posted in EmblemHealth NY, NY Providers, Training, Updates

EmblemHealth/Connecticare: Telehealth Reimbursement Policy Update for 2022

If you are a provider that accepts patients with EmblemHealth and/or Connecticare Insurance this blog post is for you!

This policy applies to Emblemhealth/Connecticare Commercial, Medicare and Medicaid Members.


Effective 01/01/2022- EmblemHealth/Connecticare has updated their telehealth policy. The following update was added:


Effective 06/01/2022- changes effect modifiers:

Want to learn more? Please click here to see the whole telehealth policy.


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