Tag: #nursingassesment

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.

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