Aetna Clinical Payment, Coding and Policy Updates

October 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:

  • Procedure: Correct Coding of Hospital Observation, Critical Care, Admission and Discharge Services
    • Update: Effective December 1, 2017, coverage will be limited for these hospital professional services to one time per day, per patient, across all providers:
      • Hospital observation services (99234 – 99236)
      • Critical care services (99291 – 99292)
      • Hospital admission services (99221 – 99223)
      • Hospital discharge services (99238 – 99239)
  • Procedure: Neuromuscular Junction Testing with Intraoperative Neurophysiology Monitoring
    • Update: Effective December 1, 2017, code 95937 will no longer be allowed when billed with codes G0453, 95940 or 95941. Modifier 59 will not override this edit.
  • Procedure: Assistant Surgeon
    • Update: Effective December 1, 2017, Aetna will retract a communication published in their March issue of OfficeLink Updates which stated more procedure would be added to codes to the assistant surgeon list effective June 1, 2017. The insurer notes: the current assistant surgeon list is not changing at this time.
  • Procedure: Pass-Through Billing
    • Update: Previously set to take effect on September 1, 2017, Aetna has changed the effective date in which they will no longer accept pass-through billing for most lab charges from a facility or a non-facility provider. The effective date will now be October 1, 2017. The provider that performs the tests must bill for these services. Aetna will pay for pass-through billing during an inpatient hospital admission and will also pay facilities for pass-through billing for members receiving outpatient services at the facility when the specimen collection occurs at the facility on the same day as other services. Aetna notes: the insurer does not reimburse for specimen collection.



Source(s): Aetna OfficeLink Updates All Regions;