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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FidelisCare-concurrent prior auth update for family and group therapy services.

This update will apply to any dos of Jan 1, 2026 and thereafter. This update does not apply to SUD services/ providers that are certified as Article 32. 29-I providers are also excluded from the concurrent prior authorization requirenments. Services affected: Family Psychotherapy – CPT Code 90847 Group Psychotherapy – CPT Code 90853    FidelisCare members have 30…

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Healthfirst Pharmacy Update Contrast agent reimbursement

The following information applies to the members in the following plans: Managed Medicaid Plans and Personal Wellness Plans (HARP) Back in 2023, NYS DOH announced that there will be a change to the pharmacy benefits for MMC, HARP members- the pharmacy benefits will be covered but NYRx. This change was finally implemented in April 2025.…

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NYS Medicaid to cover TCM (Therapeutic Transcranial Magnetic Stimulation)

The information discussed below applies to straight NYS Medicaid members for the DOS 10/1/25 and effective for any DOS on or 11/1/25 and thereafter for any Managed Medicaid Members. What is TC? A non-invasive form of brain stimulation using magnetic pulses on specific areas of the brain. This therapy is used to improve the symptoms…

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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: