Aetna Issues Notice of Pay Percent Reduction for Multiple Endoscopies

October 2019 ~

Aetna has issued a notice, informing providers that, at the end of this year, the insurer will adjust payment for multiple endoscopy procedures in the same family.

Effective December 1, Aetna will adjust payment for multiple endoscopy procedures in the same family when billed by the same surgeon or assistant surgeon on the same date of service for the same member.

Multiple surgery reductions can also apply; the multiple procedures will be ranked according to their CMS Relative Value Units (RVUs). The payment reduction is based on a formula using CMS guidelines.
Aetna provides the example:

• Elbow Arthroscopy procedures 29837 and 29834 from the same the endoscopic family reported with same surgeon or assistant surgeon are submitted for the same member, provider, and date of service.
• The procedures will be ranked according to the RVU. Procedure 29837 has the higher RVU and will be assigned a rank of 1; procedure 29834 has the lower RVU and will be assigned a rank of 2.
• A pay percent value of 0.16 will be assigned to procedure code 29837, and a pay percent value of 0.011 (0.07 x 0.16) will be assigned to procedure code 29834.

Source(s): Aetna;