Aetna New Prior Auth. Requirements for Certain Physical Medicine Services

October 2018 ~

As of September 1, 2018, National Imaging Associates, Inc. (NIA) will authorize physical therapy, occupational therapy and chiropractic services in Pennsylvania, Delaware, West Virginia and New York. The program affects non-capitated members in Aetna’s fully insured HMO/PPO commercial plans and Medicare plans.

Services that require preapproval

  • Physical therapy services performed by any provider
  • Occupational therapy services performed by any provider
  • Chiropractic services performed by any provider

For a complete list of procedures requiring an authorization, visit the NIA website.

The NIA program doesn’t apply to services performed in certain places, including therapy provided in an inpatient, home, urgent care or emergent care setting.

NOTE: Authorizations will include the approved date span and one or more Current Procedural Terminology (CPT®) codes. If more services outside of an existing authorization are required or if different codes are needed, providers must contact NIA for review and approval before submitting claims. If services are performed without approval, Aetna may deny payment. Aetna will continue to pay claims for these procedures based on the terms of the provider agreement.

CPT® is a registered trademark of the American Medical Association.
Source(s): Aetna OfficeLink Updates™ All Regions, September 2018;