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Wiki Aetna and 22853 trouble

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srpaul

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Has anyone had trouble getting Aetna to authorize 22853 for a 1 or 2 level ACDF? They are only covering structural allograft unless it is a 3 level ACDF. After speaking to all docs in my practice, none of them would perform the procedure with only structural allograft. They all said "no, Old School." Even peer to peer review can't get the device auth'd. I've had no problems with other insurance companies.
Thanks,
Shelly
 
We have the same problem. Its been going on for about a year now. We don't have our auth dept fight the 22853 for 1-2 level ACDF. All the other codes are authorized. We bill 22853 as performed and its hit or miss if Aetna pays it without an authorization. Its experimental on the Aetna policy but our providers don't use anything else. Unfortunately on the claims that 22853 has been paid on, we have to write it off.
 
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