Tag: Aetna
Aetna Fee Schedule
…Now they tell us….
POET has recently been notified by a physician office they were not paid according to the Aetna fee schedule. When the issue was brought to the attention of Aetna, they indicated the fee schedule had been updated back in April.
In the past POET has always been notified of such updates and provided a fee schedule. Yes, the fee schedule always arrived after the effective date but at least we knew it was coming. This year they have apparently chosen not to notify us. We requested the fee schedule and have received it.
We will be sending out packets for participating physicians under the POET Aetna contract. From our first glance at the fee schedule it does appear to follow CMS changes and no other surprises.
Please be on the look out for your packets late next week. If you need information sooner please call or email us.
Aetna OfficeLink Updates 6/1/2020
Changes in National Pre-certification List (NPL)
Changes to Commercial Drug list begin October 1, 2020
Accurate Claims Processing with Aetna’s 3rd Party Claim and Code Review Prog
Aetna OfficeLink Updates, Published 06/01/2020
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Open in new tab Changes in National Pre-certification List (NPL)
Changes to Commercial Drug list begin October 1, 2020
Accurate Claims Processing with Aetna’s 3rd Party Claim and Code Review Program.
CPT, HCPCS, IDC-10 and other codes you should be aware of related to COVID-19?
Aetna is complying with the CMS coding guidelines for COVID-19 lab testing.
From MGMA online community
Sharing for those that may not have seen this on Aetna’s website
What Common Procedural Technology (CPT) codes should be used for COVID-19 testing?
Aetna is complying with the CMS coding guidelines for COVID-19 lab testing. CMS adopted two CPT codes, (U0001) and (U0002), for COVID-19 testing.
- U0001 – 2019 Novel Coronavirus (2019-nCoV) Real-Time RT-PCR Diagnostic Panel should be used when specimens are sent to the CDC and CDC-approved local/state health department laboratories.
- U0002 – 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC should be used when specimens are sent to commercial laboratories, e.g. Quest or LabCorp, and not to the CDC or CDC-approved local/state health department laboratories.
For more information and future updates, visit the CMS website and its recently issued FAQs. CMS has not set pricing for COVID-19 testing, but they are expected to soon.
What CPT, HCPCS, IDC-10 and other codes should I be aware of related to COVID-19?
Reporting codes related to COVID-19 include:
ICD-10 Reporting Codes
- An emergency ICD-10 code has been created by WHO.
- Code U07.1, 2019-nCoV acute respiratory disease, will be implemented into ICD-10-CM with the update effective October 1, 2020. Until then, providers must use available ICD-10 codes and guidance.
Exposure to COVID-19
- Z03.818 (Encounter for observation for suspected exposure to other biological agents ruled out). Used for cases where there is a concern about a possible exposure to COVID-19, but this is ruled out after evaluation.
- Z20.828 (Contact with and (suspected) exposure to other viral communicable diseases). Used for cases where there is an actual exposure to someone who is confirmed to have COVID-19.
Signs and Symptoms
- For patients presenting with any signs/symptoms (such as fever, etc.) and where a definitive diagnosis has not been established, assign the appropriate code(s) for each of the presenting signs and symptoms such as:
-
- R05 (Cough)
- R06.02 (Shortness of breath)
- R50.9 (Fever, unspecified)
Inportant Information from Aetna OfficeLink Updates 3/1/2020
Changes and Updates include:
- Aetna’s National Pre-certification List, effective 7/1/2020
- Updates to Aetna’s Commercial Drug List, effective 7/1/2020
- Availity the will be Aetna’s sole Provider Portal, effective 4/30/2020
- Individual Service Codes and Service Grouping Updates, effective 6/1/2020
- Updates for In-Office Surgical Pathology Codes, effective 6/1/2020
- Updates to Drug test Thresholds, Billable Service, Notification for Acute Rehabilitation and Skilled Nursing Facilities and New Claim Edits, etc.
Aetna OfficeLink Updates 12/1/2019
Important Information for your Office. This Aetna OfficeLink Update covers a variety of topics including: Precertification, Claims Editing, Drug Coverage and much more. Click here to view this Update.
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