Nov 8, 2024 · Medicare reinstates certain pre-pandemic telehealth policies. COVID-19 public health emergency waivers that applied to Medicare Part B policies for The 2025 PFS final rule is the final word for telehealth services effective Jan. 1, 2025, unless Congress acts.

May 24, 2019 · Now, I couldn't find Aetna's E/M policy, but I would be very surprised if they decided to deviate too much on that sense. Possible reasons for the denial:-The patient was seen by the same provider at a previous practice, within 3 years-The patient was seen by a similar credentialed provider from the same practice (fairly common denial reason)

May 1, 2023 · Just an FYI to the article from the author: The use of the -93 modifier is currently active, but optional. CMS has stated that the -95 modifier is for Telehealth services through 2024, due to payment parity.

Nov 11, 2017 · Aetna insurance frequently denying CPT 81003 or 81002 charges as inclusive with E&M service (99201-99395). Initially I tried with modifier “25” to E&M, after that I even tried with an appeal, but no use, it denied as inclusive again. In this case I need clarification that, is there any payer policy in Aetna website regarding this.

Oct 20, 2022 · Sometimes it gets denied but then will go through after appending the 59-mod to it. If the corrected claim gets denied, then I submit an appeal with medical records; but lately even with the appeal it's been getting denied. It's a hit or miss. If all else fails, I call Aetna directly and have them send it back to be reviewed.

Oct 5, 2021 · Hello All, We are getting denials for the codes 99203-99205 outpatient office/hosp. and 99221-99223 inpatient, Aetna is stating they only pay 1 provider of this group of codes per patient per day across all providers.

Jan 15, 2025 · Rulemaking and lawmaking keep telemedicine a viable solution for the masses, for now. Now that the dust has settled on the American Relief Act, 2025, Medicare policy for telehealth services is extended through March 31, but then what?

Through Dec. 31, 2024, there are no geographic restrictions for patients or providers. For Medicare, use the place of service code that identifies where the patient is located: POS 02 when the patient is not at home or POS 10 if the telehealth is provided in the patient’s home.

Dec 18, 2024 · Aetna - Follow Medicare (per their risk adjustment inquiry team– no updated policy of their own yet) BCBS - Follow Medicare (may want to check on this later to see if they update) Cigna - Yes to new codes (per rep)/Policy will update at end of Jan (may want to wait until then to use the new codes)

Nov 1, 2011 · Due to the fact that we have several patients who have Aetna, in addition to Medicare, and/or other primary/supplemental payers (whose policies and protocol are based on logical, and widely-accepted rationale); and, due to the fact that it would be unreasonable to employ special billing practices that are both unnecessary, and grossly incorrect ...