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 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.

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.

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.

Jul 2, 2013 · Can you please share me the Aetna Insurance policy details, which state we can only bill 120 units for 95165 in a 365-day period or 30 every 3 months but found this for Allergy test but no information about serum mix. Number: 0038 (Replaces CPB 326) 0038-Allergy Testing and Allergy Immunotherapy; Thank you.

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)

Oct 25, 2010 · per Encoder these 2 codes are not bundled. The report combines the findings into one but is clearly two approaches. The insurance I am having an issue with is Aetna. They are inconsistent however always bundle one into the other and only pay for one-sometimes the transvag and sometimes the pelvic ultrasound.

Aug 8, 2019 · We had a claim for 99222 that was denied by Aetna since another provider had billed for it first. We are the attending physician (and was the one who asked for a consult with the other provider) so I appended the modifier -AI, sent in the corrected claim with reconsideration form but they still denied it.