1. L

    Question coverage for 96127 for Aetna

    Does anyone know if Mental health providers (psychologist/trist) can bill 96127? We used to bill it with a 90846 or 90847 years ago, but we now know they are bundled. Has anyone billed this code on its own on a separate claim? or the day prior or the following day of the therapy visit? Any...
  2. E

    Question Billing hydration services J7030, J7040?

    Good afternoon, Recently we started receiving denials from Aetna (no other payers at this time) stating that when we are billing hydration services 96360, 96361 we are not allowed to bill the saline solution J7030, J7040 as they are bundled with the procedure. We have not had issues with this...
  3. E

    Question Aetna Credentialing/Contracting

    I work as the credentialing specialist for an ABA therapy group and experience the worst time with Aetna and their processes. Does anyone happen to know of anything helpful in moving along their process of credentialing, on boarding and demographic loading? I submit applications to Aetna and...
  4. L

    Question patient cost estimator/availity/aetna

    Has anyone found an alternative to get patient cost estimates from Aetna that doesnt requiring calling them directly? I work for a behavioral health practice and we have obtain estimates on neurological testing. Availity's patient cost estimator tool has not worked for a long time. Availity...
  5. K

    Billing Aetna for non-hospice related surgery

    I'm hoping someone can point me in the right direction, I don't have much experience with hospice. Patient has Aetna PPO Medicare Replacement/Advantage plan. My doc performed an ORIF for fractured femur after seeing pt in ER. I billed Aetna and turns out she's on hospice. I added the GW...
  6. eharloff

    Depression Screen

    I have a quick question regarding depression screening. So this patient came in for her CPE, we did a depression screen and billed it 96127, G8510, her insurance adjusted $12.74 off and is leaving $5.26 toward her deductible. My question is, can we bill this to her or do we write it off since...
  7. E

    Question 99358

    We are billing 99358 to BCBS and Aetna medicare advantage plans and medicaid. They are denying this code. Is anyone else having this issue? Is there something we can be doing to get this paid? We are billing for nursing facilities. The providers review patient records before being seen in facility.
  8. J

    Question Aetna Medicare Mid-Level E/M

    Our office is having problems with Aenta Medicare (specifically Aetna Medicare Elite and Premier) denying our Physician Assistant E/M charges stating the provider type is ineligible to bill/perform the service (PI-170). They will pay other services on the claim, if any, (like a UA, EKG, etc) but...
  9. S

    Provider moving practice location

    Hello everyone! We have a provider who left her previous practice, and is joining ours. We bill everything with our group NPI and tax ID, but individual NPI as rendering. We are in mental health, and she is our first prescriber (DNP). Everyone else at the practice is LPC, MSW, or LP. She is...
  10. C

    Question J1100 - Experimental

    I work for a small general practice facility. We have 7 providers and they all use Decadron, J1100, for illnesses that cause inflammation, ie: sinusitis, allergic rhinitis, myalgia, etc. We are currently getting consistent denials from Aetna for this medication as experimental. All other...
  11. A

    Aetna shorting single-patient payments

    Has anyone experienced receiving EFTs that are short on the payment amount without any type of takeback on their single-patient payments? This has only happened on remittances with 1 patient on them. This just began happening to less than 2 months ago. I've called Aetna and the representatives I...
  12. B

    Telemedicine Telehealth Denials Aetna Texas

    Hi all, This is my first time posting, so I hope I'm in the right forum and also not repeating someone else's question. This question is specifically for Aetna in Texas but any feedback is appreciated. I am getting no where fast when trying to get reimbursement from Aetna for Televisits...
  13. V


    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 pays with modifier 50. We don't have many aetna...
  14. A

    Aetna - ABA Therapy Denials

    Hi! I've been working with a billing team on our ABA billing to Aetna. Prior to supplying services, we obtain an authorization for the 4 codes we bill (0364T/0365T and 0368T/0369T). The problem is this: Starting in October, Aetna has denied every claim for 1 out of the 4 kids for "Charges...
  15. R

    WHO SHOULD GET THE REFUND? Both Medicare and Aetna paid as primary

    We have a patient in which both Medicare and Aetna paid for multiple dates of service as primary payers. Our office contacted both insurance companies who assured our office that they were in fact the primary payer. In turn, we contacted the patient to ask that they contact Medicare and Aetna...
  16. V

    Appropriate code for billing UDS - BCBS and AETNA

    Hi all, Recently we are receiving denials from AETNA for 2016 claims as " Need to bill with appropriate HCPCS" , currently we are billing 8-series codes for confirmatory tests. The same issue for BCBS. Please help on the above cases as we need to bill HCPCS/CPT code for BCBS and AETNA...