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  • aetna | Medical Billing and Coding Forum - AAPC
    Aetna breast cancer patient had delayed reconstruction so the doctor inserted bilateral implants I coded 19342 with modifier 50 and aetna only paid for one side, do i need to bill with rt and lt modifiers to receive proper reimbursement?
  • Wiki - AETNA and G2211 | Medical Billing and Coding Forum - AAPC
    I was also researching as the big commercial insurances have and or are in the process of adding policies specific to G2211 - Here is what I located from Aetna- Hope this helps
  • Aetna E M Policy | Medical Billing and Coding Forum - AAPC
    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)
  • Wiki - BCBS and Aetna bundling 90480 - AAPC
    BCBS and Aetna are bundling CPT code 90480 (COVID vaccine administration) when billed with COVID vaccine codes 91321 or 91322 AND a flu vaccine (90656) with vaccine admin code 90460 If we bill if we bill 90480 and 91321 (or 22) alone, the 90480 is paid This bundling issue just started in
  • Wiki - Aetna denying G2212 stating this is an add on code
    We billed 99215 and G2212 (Prolonged out patient office visit) to Aetna (since provider spent more than 55 minutes) but they paid for 99215 and denied G2212 stating "This claim is being denied for one of two reasons: - We did not receive a claim for the primary service performed Add-on codes
  • Wiki - Billing Radiation Therapy Codes 77301 and 77014
    Aetna 77387 reimbursement rate We had the same issues with Aetna not accepting 77014 After appeals and disputes with provider representatives and medical directors, Aetna refused to accept 77014 The reimbursement for 77387 is significantly less than 77014, therefore, we came to an agreement to bill 77387, and Aetna agreed to reimburse 77387 with a rate comparable to 77014 An amendment was
  • Aetna denials for 59425 and 59426 - want # of units - AAPC
    Wiki Aetna denials for 59425 and 59426 - want # of units - denying 1 unit- and want all dates on claim? Patricia Donegan Mar 8, 2023 Create Wiki Sort by date
  • Wiki - Aetna downcoding of E M claims - AAPC
    Is anyone else noticing Aetna E M claims being randomly downcoded without any justification? We have had many 99214 downcoded to 99213, even though the MDM supported the 99214 If you are experiencing this and likely appealing, have you had any success in getting these decisions overturned?
  • Wiki - Aetna Medicare Denials LCD for office visit 99213
    Has anyone had denials for LCD on a office visit for 99213 from Aetna Medicare? This just started Oct 1, 2022 so I'm assuming new fiscal years Claims are being denied for LCD on an office visit with psychiatric DX codes, (these are not dementia or cognitive impairment codes) Medicare
  • Wiki - CPT 81003 inclusvie denieal from Aetna. - AAPC
    Hi all, 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





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