Tag: #occupationalthearpy

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

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

Posted on by KR2Medical Billing

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.

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NYS Medicaid POC Syphilis testing coverage

Effective for any DOS August 2025 and thereafter Point of Care testing for Syphilis is covered for all fee fo service Medicaid and Managed Medicaid Members. Where is this test covered (POS)? physician/nurse practitioner/licensed midwife private office setting What kind of POC is covered and reimbursed? Currently there is only one FDA approved test -Clinical…

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NYS Medicaid OBGYN CPT II codes reporting requirement

If you are a provider in NY and accept Managed Medicaid or Fee-for-service Medicaid plan types, then this blog post post is for you! For any DOS (for deliveries on July 1, 2024) and thereafter, the OBGYN providers billing bundled/global OBGYN codes, are also required to bill the following CPT II reporting codes. Global OBGYN…

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NYS Medicaid: Bariatric Surgery Medical Policy Update

Do you accept NYS Medicaid or Managed Medicaid Plan members? Then this blog post is for you! Non surgical treatment should be attempted: ex. diet and increased exercise. Bariatric Surgery Adult Patient: 18 years old and over Pediatric patients: 18 years and older – patients that are deemed physically, mentally, and emotionally mature by a…

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Posted in #aetna, #Medicareadvantage, Training, Updates

Aetna Medicare Advantage: Home Health Program in KY, OH, MO

Posted on by KR2Medical Billing

Since 08/01/2021 Aetna has partnered with myNEXUS, a technology-enabled care management company, to manage the network, claims payment and precertification/prior authorization program for home health services.

Note the following changes for the Providers:

Prior approval changes:

  1. Effective for DOS 01/01/2022 and thereafter, myNEXUS will require advance approval for all home-health-related requests for in-home skilled nursing, physical therapy, occupational therapy, speech therapy, home health aide, and medical social work.
  2. If you would like to view the full home health care pre-auth list, please click here (insert link)

Claim Payment and Processing changes:

  1. Effective for DOS 01/01/2022 and thereafter, myNEXUS will pay claims for covered home health services, for Kentucky, Ohio and Missouri Medicare Advantage members
  2. Reimbursement rates will correspond to the rates and terms of your myNEXUS contract.

Important!

1.These above changes apply only to the Aetna Medicare Advantage Members that reside in the three states, and/or Aetna Medicare Advantage DSNP members, in the above mentioned 3 states.

2. These changes DO NOT APPLY TO THE FOLLOWING:

Medicare members residing outside of the states of Kentucky, Ohio and/or Missouri

Aetna and Coventry commercial fully insured HMO/POS/PPO plans • Aetna administrative services only (ASO) self-funded HMO/POS/PPO plans

Aetna Student Health℠

Aetna Global Business • Coventry Workers’ Compensation  

Cofinity®

First Health®, Meritain® Health, Traditional Choice®

Aetna Signature Administrators® 

Where do I order a prior approval?

  1. Online: myNEXUS portal to get started or

2. Fax the authorization request form to 1-866-996-0077

Find this type of content helpful? Follow my blog for more payer network news, medical billing and coding updates, reimbursement/medical policy changes.

Recent Blog Posts:

Posted in #aetna, #Medicareadvantage, Training, Updates

Aetna Medicare Advantage: Home Health Program in KY, OH, MO

Posted on by KR2Medical Billing

Since 08/01/2021 Aetna has partnered with myNEXUS, a technology-enabled care management company, to manage the network, claims payment and precertification/prior authorization program for home health services.

Note the following changes for the Providers:

Prior approval changes:

  1. Effective for DOS 01/01/2022 and thereafter, myNEXUS will require advance approval for all home-health-related requests for in-home skilled nursing, physical therapy, occupational therapy, speech therapy, home health aide, and medical social work.
  2. If you would like to view the full home health care pre-auth list, please click here (insert link)

Claim Payment and Processing changes:

  1. Effective for DOS 01/01/2022 and thereafter, myNEXUS will pay claims for covered home health services, for Kentucky, Ohio and Missouri Medicare Advantage members
  2. Reimbursement rates will correspond to the rates and terms of your myNEXUS contract.

Important!

1.These above changes apply only to the Aetna Medicare Advantage Members that reside in the three states, and/or Aetna Medicare Advantage DSNP members, in the above mentioned 3 states.

2. These changes DO NOT APPLY TO THE FOLLOWING:

Medicare members residing outside of the states of Kentucky, Ohio and/or Missouri

Aetna and Coventry commercial fully insured HMO/POS/PPO plans • Aetna administrative services only (ASO) self-funded HMO/POS/PPO plans

Aetna Student Health℠

Aetna Global Business • Coventry Workers’ Compensation  

Cofinity®

First Health®, Meritain® Health, Traditional Choice®

Aetna Signature Administrators® 

Where do I order a prior approval?

  1. Online: myNEXUS portal to get started or

2. Fax the authorization request form to 1-866-996-0077

Find this type of content helpful? Follow my blog for more payer network news, medical billing and coding updates, reimbursement/medical policy changes.

Recent Blog Posts: