Aetna – Clinical Payment and Coding Policy Changes

February 2018 ~

Aetna has released its latest clinical payment and coding policy changes, including changes to its observation policy, eligibility updates for assistant surgeons and surgical assistants, and expanded claims edits.

The following clinical payment and coding policy changes will become effective summer 2018:

Eligibility of Assistant Surgeons and Surgical Assistants

Effective June 1st, Aetna will make changes to some of the procedures it considers eligible for assistant surgeons and surgical assistants for Coventry commercial and participating Medicare claims, in accordance with the insurer’s current policy.

Expanded Claims Edits

Along with the new third-party claims edits added in December, Aetna will further expand its claims editing capabilities by implementing additional edits effective June 1st.

These edits can be viewed on Aetna’s provider website under Expanded Claims.

Observation Policy

Effective July 1st, Aetna will no longer require notification for observation greater than 24 hours and will no longer cover observation services that extend beyond 48 hours.


Source(s): Aetna OfficeLink Updates™ All Regions;