Aetna HCPCS Code Updates to Specific Drug Contract Service Groupings
December 2019 ~
As of March 1, 2020, Aetna will implement code changes to specific drug contract service groupings that will impact provider’s compensation dependent upon the presence or absence of specific service groupings within the contract. The changes can be seen below.
Codes: 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 and All Other Drugs
- All Other Drugs
Codes: 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 and All Other Drugs
- All Other Drugs
- All Drugs, agents, inj. Drugs
- Injectable Drugs
- All Outpatient Drugs including C, J, Q and S codes
Codes: J9022, J9023, J9203, J9285
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:
- 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
Codes: 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 and All Other Drugs
- All drug or drug agents without specific rate set forth above or herein
Codes: 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, and skilled nursing facilities
Update: These codes will be removed from the following contract service grouping:
- Chemotherapy Drugs
Source(s): Aetna OfficeLink Updates, December 2019;
