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?
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...
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. They are claiming that the code can only be billed once per day. I checked again and CMS ...
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)