Aetna HCPCS Code Updates to Specific Drug Contract Service Groupings

February 2020 ~

Effective March 1, Aetna will implement code updates under which individual service codes will be assigned within contract service groupings. Changes to an individual provider’s compensation will depend on the presence or absence of specific service groupings within the contract.

These changes are outlined below.

Code(s): J1095, J2186, J2787

Provider Types Affected: Facilities including acute short-term hospitals, free-standing ambulatory surgery centers, and skilled nursing facilities

Update: These codes will be added to the following contract service groupings:

• All drugs or drug agents without specific rate set forth above or herein
• Drugs
• Chemotherapy and All Other Drugs
• Chemotherapy & All Other Drugs
• All Other Drugs

 Code(s): Q5109, Q5111

Provider Types Affected: Facilities including acute short-term hospitals, free-standing ambulatory surgery centers, skilled nursing facilities, infusion facilities, dialysis facilities, physician providers, home health providers

Update: These codes will be added to the following contract service groupings:

• All drugs or drug agents without specific rate set forth above or herein
• Drugs
• Chemotherapy and All Other Drugs
• Chemotherapy & All Other Drugs
• All Other Drugs
• All Drugs, agents, inj. Drugs
• Injectable Drugs
• All Outpatient Drugs including C, J, Q and S codes”

 Code(s): J9022, J9023, J9203, J9285

Provider Types Affected: Facilities including acute short-term hospitals, free-standing ambulatory surgery centers, skilled nursing facilities

Update: These codes will be added to the following contract service groupings:

• Drugs
• Chemotherapy and All Other Drugs
• Chemotherapy and All Other Drugs
• Chemotherapy Drugs
• All drugs or drug agents without specific rate set forth above or herein

Code(s): J3591

Provider Types Affected: Facilities including acute short-term hospitals, free-standing ambulatory surgery centers, skilled nursing facilities, infusion facilities, dialysis facilities, physician providers, home health providers

Update: These codes will be added to the following contract service groupings:

• Drugs
• Chemotherapy and All Other Drugs
• All Other Drugs
• Chemotherapy & All Other Drugs
• All drug or drug agents without specific rate set forth above or herein

Code(s): J0185, J0517, J0567, J0584, J0599, J0841, J1301, J1454, J1628, J1746, J2062, J2797, J3245, J3304, J3397, J3398, J7170, J7177, J7203, J7318, J7329, Q9991, Q9992, Q5105, Q5106, Q5108, Q5110

Provider Types Affected: Facilities including acute short-term hospitals, free-standing ambulatory surgery centers, skilled nursing facilities

Update: These codes will be removed from the following contract service grouping:

• Chemotherapy Drugs

Source(s): Aetna Office Link Updates, December 2019;