Wiki Aetna & POS 11

[DawnB2019]

We do certain procedures in our office. I work for an ENT. Aetna has been denying CPT 30520 when done in POS 11 (under CS). They are only denying 30520 for POS however the other codes billed the same day (31298,31295 & 31254) are being denied as experimental/investigational. No other insurances, including Medicare/Medicaid, are denying these when done in POS 11 except for Aetna.
Is anyone else seeing these denials? Aetna reps cannot give me the exact policy/guidelines they are using for these denials.

Any and all feedback/help is greatly appreciated.

Thank you
Dawn B.

 

[vanessamoldovan]

We do certain procedures in our office. I work for an ENT. Aetna has been denying CPT 30520 when done in POS 11 (under CS). They are only denying 30520 for POS however the other codes billed the same day (31298,31295 & 31254) are being denied as experimental/investigational. No other insurances, including Medicare/Medicaid, are denying these when done in POS 11 except for Aetna.
Is anyone else seeing these denials? Aetna reps cannot give me the exact policy/guidelines they are using for these denials.

Any and all feedback/help is greatly appreciated.

Thank you
Dawn B.

http://www.aetna.com/cpb/medical/data/1_99/0005.html