Aetna cpt code reimbursement

Under the policy, we'll reimburse for two-way, real-time audiovisual interactive communication between the patient and the health care practitioner. This interaction does not include direct patient contact, but the patient must be present and take part throughout the interaction.

aetna cpt code reimbursement

This updated policy will take effect as of January 1, At that time, you will be able to review the payment policy and approved codes on the provider website. When billing for eligible services rendered via telemedicine, as explained above, you must bill them using the appropriate telemedicine modifier representing two-way, real-time audiovisual interactive communication.

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Utilization management. Update medical provider data.This policy covers the cost of a physician-ordered test and the office, clinic or emergency room visit that results in the administration of or order for a COVID test.

The test can be done by any approved laboratory. This member cost-sharing waiver applies to all Commercial, Medicare and Medicaid lines of business. The policy aligns with new Families First legislation requiring all health plans to provide coverage of COVID testing without cost share.

The requirement also applies to self-insured plans. Commercial labs are in the process of updating their provider community about their capabilities and how to order tests. Instead, an appropriate specimen should be collected at the health care facility where the patient was seen and the test was ordered. The specimen should be sent to these laboratories using standard procedures. Quest Diagnostics. Accurate Diagnostics Labs. Sonic Healthcare CBL. To check whether other commercial labs, hospitals or urgent care centers are authorized to provide COVID lab testing, visit their respective websites.

By submitting a claim to Aetna for COVID testing, providers acknowledge that the above amounts will be accepted as payment in full for each COVID test performed, and that they will not seek additional reimbursement from members.

Quest and LabCorp will not collect specimens for the test. Patients for whom testing has been ordered should not be sent to a Quest or LabCorp location or their draw sites to have a specimen collected. Test results will be available in three to four days. The physician office will put in a sealed envelope and ship it out to the lab.

The labs will communicate and educate the providers offices on using the appropriate lab testing equipment and submitting to their reference lab. Commercial labs have been preparing for additional testing capabilities. Aetna is in contact with commercial labs and tracking the availability of new lab tests. This policy applies to all Aetna-insured commercial plan sponsors and is effective immediately for any such admission through June 1, Self-insured plan sponsors will be able to opt-out of this program at their discretion.

We will also cover the cost of the hospital stay for all of our Medicare Advantage members admitted March 25, through June 1, Regulations regarding cost-sharing for Medicaid beneficiaries vary by state and continue to evolve in light of the current situation. We have suspended cost-sharing requirements, including premiums and copays, for adults and children covered by Medicaid and CHIP, in those states where permitted to do so by the appropriate regulators.

This change is effective immediately and will apply to any such admission between March 25, and June 1, All claims received for Aetna-insured members going forward will be processed based on this new policy. If in-patient treatment was required for a member with a positive COVID diagnosis prior to this announcement it will be processed in accordance with this new policy.

In the event a claim has already been processed prior to this policy going into effect, members should contact Customer Service so the claim can be reprocessed accordingly.

No, Aetna will pay the amount of the cost-sharing the member would have ordinarily paid so the provider would receive the same total payment. Stay up to date and find state resources, like testing sites, updated case counts, facts from the Centers for Disease Control and more. COVID state resources. Visit the CDC. Visit WHO. Visit CVS Health.

aetna cpt code reimbursement

Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies, including Aetna Life Insurance Company and its affiliates Aetna. This material is for information only. Health information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professional.

Information is believed to be accurate as of the production date; however, it is subject to change.Our goal is to keep you as well informed about our plan as possible. Be sure to check this page often. We regularly augment our clinical, payment and coding policy positions as part of our ongoing policy review processes. In an effort to keep our providers informed, please see the below chart of upcoming new policies. An Excludes 1 Note indicates that the excluded code identified in the note should never be used at the same time as the code or code ranges above the Excludes 1 Note in the ICD10 manual.

Our updated telemedicine policy

An Excludes 1 Note is used to indicate when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition. These conditions are mutually exclusive code combinations. Thank you for your continued commitment to improving the health of our members — your patients.

With a few exceptions listed below, these codes will no longer be managed through the prior authorization process. They will be managed with Medical Records at the time of claim submission. That is, records supporting the use of these codes must be submitted with the claim. If records are not submitted with any claim including one of the codes listed below, the claim will be denied for lack of documentation.

You may resubmit the claim with required supporting records. ACIP regularly reviews all formulations of vaccines and updates its list of recommended vaccines. In previous years, the list included a live attenuated Influenza vaccine LAIV for individuals aged in a nasal spray formulation Flumist. ACIP continues to recommend annual flu vaccination with either the inactivated influenza vaccine IIV or recombinant influenza vaccine RIV for everyone 6 months and older.

These vaccines are available through a participating pharmacy. Skip to main content Main Navigation. Provider notices Subject: New Policy Updates - Clinical Payment, Coding and Policy Changes Date: July 1, We regularly augment our clinical, payment and coding policy positions as part of our ongoing policy review processes.

Subject : Fluoride varnish Date : Oct. Only trained providers will be reimbursed.If your browser is in Private mode, pages that use personal or geographic information may not work. Learn more about private mode. Submitting your claims electronically is quick, convenient and easy. Choose the option that works best for you. Explore claims options. Receive payments directly to your account.

And review claims payment information online any time. Learn more about electronic tools. Get timely payments with electronic coordination of benefits COB when a patient is covered under more than one insurance plan. Submit COB claims. Discover time-saving tools.

aetna cpt code reimbursement

Look up electronic transaction vendors. Estimate how much your patients will owe for an office visit. Or look up how much we reimburse for services. Learn how to estimate payments. Log in to see fee schedules.

Please accept these alternate formats. You can get a patient's digital member ID card by submitting an eligibility inquiry on our secure provider website, or through Availity. ID cards can be saved and printed. Login to your secure provider website. See your savings from electronic transactions. Some of our plans pay for services from doctors who are not in our network. Find out how we figure our charges. Aetna Medicare nonparticipating provider information. Whether we notify you about an overpayment or your office identifies it, we provide simple steps to refunding.

See how to refund overpayments. Find out what ASA means for you. In order to have the best experience on Aetna.Post a Comment. Procedure code,- telephone consult. Psychiatrists and clinical psychologists may only bill for these services when also providing consultation or evaluation.

The codes are differentiated according to the length of the medical discussion with the patient. These codes are used only for services personally performed by a physician. Procedure codes describe telephone services performed by qualified non-physician health care professionals.

Therefore, while Medicare does not cover these services, some private payers could potentially cover these services and use the RVUs assigned by Medicare to set payment rates.

Billing Information

ASTRO recommends you review the current policies of your major payers to determine their coverage policies regarding telephone evaluation management services. Phone calls during treatment are included in the work captured in Procedure code which includes a day global period after treatment is completed. OVERVIEW This policy describes reimbursement for Telemedicine and Telehealth services, which are services where the physician or other healthcare professional and the patient are not at the same site.

Examples of such services are those that are delivered over the phone, via the Internet or using other communication devices. This policy does not address care plan oversight services see the Care Plan Oversight. The modifiers below describe the technology used to facilitate a Telehealth encounter. One of these modifiers should be reported when performing a service via Telehealth to indicate the type of technology used and to differentiate a Telehealth encounter from an encounter when the physician and patient are at the same site.

For more information, see the Definitions section below. When reporting modifier GT, the physician, hospital, ambulatory surgical center, or qualified healthcare professional is certifying that they are rendering services to a patient located in an eligible Originating Site via an Interactive Audio and Visual Telecommunications system.

These practitioners may not bill or receive payment for Current Procedural Terminology CPT codes,and The use of modifier GT indicates a Telehealth service was performed by an eligible practitioner via an Interactive Audio-Visual Telecommunications system and the patient was present at an eligible Originating Site. Oxford will also reimburse CPT codes T and T when these codes are reported with or without a modifier GT, since the description for these codes indicates a Telehealth service and the technology used.

For example, a pediatrician receives a call from a mother at 2 A. The physician is able to handle the situation over the phone without requiring the child to be seen in an emergency room.

Billing & Reimbursement - 2018 Medicare Update

This service is considered included in the overall management of the patient.Like with all major insurance companies, Aetna requires mental health providers to utilize their normal range of CPT codes.

Common CPT codes for Telehealth can be found at our telehealth billing guide. You can call, text, or email us about any claim, anytime, and hear back that day. We are your billing staff here to help. Our mental health insurance billing staff is on call Monday — Friday, 8am-6pm to ensure your claims are submitted and checked up on with immediacy. We understand that it's important to actually be able to speak to someone about your billing.

Every provider we work with is assigned an admin as a point of contact. You'll always be able to get in touch. You want to get paid quickly, in full, and not have to do more than spend 10 or 15 minutes to input your weekly calendar. You want to know you can call your billing admin, a real person you've already spoken with, and get immediate answers about your claims.

Learn how to offload your mental health insurance billing to professionals, so you can do what you do best. Add in the unnecessarily difficult insurance billing system and we run the risk of working way over full-time.

Aetna Telehealth Billing for Therapy and Mental Health Providers

TheraThink provides an affordable and incredibly easy solution. My daily insurance billing time now is less than five minutes for a full day of appointments. Denny and his team are responsive, incredibly easy to work with, and know their stuff.

I cannot capture in words the value to me of TheraThink. Thank you. You free me to focus on the work I love! Billing Aetna for telehealth therapy services and general telemedicine for mental health is straightforward, fortunately. Review our short guide to understand how to code Aetna telehealth billing in general and psychotherapy in particular. Inquire about our mental health insurance billing service. Get Your Billing Handled! It's our goal to ensure you simply don't have to spend unncessary time on your billing.

You want to not have to deal with it!What you need to know: Get the latest information about the coronavirus.

Below is COVID testing, coding and other information that might be helpful to health care providers. Visit the CDC. Visit WHO. Visit CVS Health. Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies, including Aetna Life Insurance Company and its affiliates Aetna. This material is for information only. Health information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professional.

Information is believed to be accurate as of the production date; however, it is subject to change. See all legal notices. Links to various non-Aetna sites are provided for your convenience only.

Aetna Inc. The information you will be accessing is provided by another organization or vendor. If you do not intend to leave our site, close this message. Contact us Espanol. Join our network. How to apply. Patient care program overview Health care report cards Aetna specialty institutes Aexcel performance networks Physician advisory board. Getting started as a new provider. Health care providers. Pharmacy services.

aetna cpt code reimbursement

Drug lists. Pharmacy clinical policy bulletins. Update pharmacy data. CPT code search. Clinical policy bulletins. Clinical policy bulletin overview Medical clinical policy bulletins Dental clinical policy bulletins Pharmacy clinical policy bulletins. Utilization management. Update medical provider data.


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