Aetna Clinical Payment, Coding and Policy Updates

December 2017 ~

Aetna has announced several policy changes impacting clinical payments, coding and medical billing that will take effect over the next few months. These updated policies are as follows:

Multiple Procedure Reduction for Diagnostic Cardiology Services

Effective March 1st, 2018, Aetna will begin reducing the allowable amount of multiple diagnostic cardiology services by 25%. This change does not apply to the service with the highest relative value units (RVU) rate.

This change applies to the technical component (TC) of the RVU only, for:

  • Services on the same date of service
  • Services billed by a single provider
  • Services billed for the same patient

Multiple Procedure Reduction for Diagnostic Ophthalmology Services

Effective March 1st, 2018, Aetna will begin reducing the allowable amount of multiple diagnostic ophthalmology services by 20%. This change does not apply to the service with the highest RVU rate.

This change applies to the TC of the RVU only, for:

  • Services on the same date of service
  • Services billed by a single provider
  • Services billed for the same patient

Multiple Procedure Reductions for Therapy Services

Aetna applies multiple procedure reductions to certain therapy services. The insurer will pay 100% of the therapy service the highest practice expense (PE) RVU. Aetna reduces the PE RVU portion of the total RVU by 50% for more therapy services performed on the same day.

Payment and Coding Policy Changes

Aetna’s standard payment policies do not reimburse services that we consider incidental to the overall episode of care. This includes supplies, materials and equipment such as:

  • Sutures or suture substitutes
  • Dressings
  • Syringes
  • Gauze
  • Catheters
  • Guide wires
  • Stationary devices
  • Parenteral infusion pumps

Starting March 1, 2018, the Healthcare Common Procedure Coding System (HCPCS) codes C2617, C2625, C1752, C1769, C1770, C2623 and C1884 will be considered incidental. There will be no additional payment for these items.

 

 

Source(s): Aetna OfficeLink Updates;

 

 

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