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?
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...
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)
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
Wiki - AETNA and G2211 | Medical Billing and Coding Forum - AAPC
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 - Aetna denying G2212 stating this is an add on code
Hello! Aetna has been denying our telehealth visits billed with modifier 93 when the video connection fails and the visit is completed as audio-only. (99214-93) I called and spoke with a representative who confirmed that Aetna is no longer accepting modifier 93. He advised us to use modifier 95...