Nov 8, 2024 · Medicare reinstates certain pre-pandemic telehealth policies. COVID-19 public health emergency waivers that applied to Medicare Part B policies for The 2025 PFS final rule is the final word for telehealth services effective Jan. 1, 2025, unless Congress acts.

May 24, 2019 · Now, I couldn't find Aetna's E/M policy, but I would be very surprised if they decided to deviate too much on that sense. Possible reasons for the denial:-The patient was seen by the same provider at a previous practice, within 3 years-The patient was seen by a similar credentialed provider from the same practice (fairly common denial reason)

May 1, 2023 · Just an FYI to the article from the author: The use of the -93 modifier is currently active, but optional. CMS has stated that the -95 modifier is for Telehealth services through 2024, due to payment parity.

Jul 2, 2013 · Can you please share me the Aetna Insurance policy details, which state we can only bill 120 units for 95165 in a 365-day period or 30 every 3 months but found this for Allergy test but no information about serum mix. Number: 0038 (Replaces CPB 326) 0038-Allergy Testing and Allergy Immunotherapy; Thank you.

Oct 20, 2022 · Sometimes it gets denied but then will go through after appending the 59-mod to it. If the corrected claim gets denied, then I submit an appeal with medical records; but lately even with the appeal it's been getting denied. It's a hit or miss. If all else fails, I call Aetna directly and have them send it back to be reviewed.

Nov 11, 2017 · Aetna insurance frequently denying CPT 81003 or 81002 charges as inclusive with E&M service (99201-99395). Initially I tried with modifier “25” to E&M, after that I even tried with an appeal, but no use, it denied as inclusive again. In this case I need clarification that, is there any payer policy in Aetna website regarding this.

Through Dec. 31, 2024, there are no geographic restrictions for patients or providers. For Medicare, use the place of service code that identifies where the patient is located: POS 02 when the patient is not at home or POS 10 if the telehealth is provided in the patient’s home.

Aug 8, 2019 · We had a claim for 99222 that was denied by Aetna since another provider had billed for it first. We are the attending physician (and was the one who asked for a consult with the other provider) so I appended the modifier -AI, sent in the corrected claim with reconsideration form but they still denied it.

Nov 1, 2011 · Due to the fact that we have several patients who have Aetna, in addition to Medicare, and/or other primary/supplemental payers (whose policies and protocol are based on logical, and widely-accepted rationale); and, due to the fact that it would be unreasonable to employ special billing practices that are both unnecessary, and grossly incorrect ...

May 7, 2014 · Because AETNA does not crendential NP any claims submitted by an NP to AETNA would be denied. If the NP sees an AETNA patient, the visit can be billed under the Physician NPI number, however, the physician will need to co-sign the notes. In this case the physician would have to examined the patient and agreed with the NPs findings.