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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)
Telehealth 2025: The Final Rule - AAPC Knowledge Center 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
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 - 95165 and Aetna | Medical Billing and Coding Forum - AAPC We have been getting denials from Aetna insurance when billing our 95165 They state you can only bill 120 units for 95165 in a 365 day period or 30 every 3 months If we use our 120 units and still have serum to make and bill can we switch to billing 95125 even though their serum is
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
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?
INCIDENTAL DENIALS | Medical Billing and Coding Forum - AAPC AETNA MEDICARE INSURANCE, THIS CLAIM IN PARTICULAR IS A E M WITH MODIFIER 25, WITH 69210 OVER HAS BEEN PAID BUT NOT THE 69210, FOR ME TO APPEAL THIS WOULD BE DIFFERENT KIND OF APPEAL THEN A BUNDLED DENIAL?
99221-99223 denials | Medical Billing and Coding Forum - AAPC 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
Wiki - 36415 denials | Medical Billing and Coding Forum - AAPC My claims for Cigna and Aetna are being denied for the 36415 when performed with an office visit the lab bills the lab tests, we bill the venipuncture Is anyone out there getting paid for the 36415 for these insurance companies?
Wiki - 76830 and 76856 | Medical Billing and Coding Forum - AAPC The insurance I am having an issue with is Aetna They are inconsistent however always bundle one into the other and only pay for one-sometimes the transvag and sometimes the pelvic ultrasound When a 59 is appended to the bundled code (which goes against coding guidelines) the once-bundles denied code is paid