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;

 

 

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