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.

 

[fwnewbie]

Maybe they have specific guidelines against doing the septoplasty in an office setting and you have to follow that if you want paid?
And surely they have to have some documentation on this policy because how can you follow it if you have no guidelines from them? That's frustrating but keep after them for proof that if would be denied before the DOS because if they can't show you in writing that this restriction was in place at that time, they should have trouble denying payment. IMO