Wiki Chemotherapy pump billing to Aetna insurance

[dlpirtle]

Does anyone know if you use the E0781 chemo non-disposable pump or the A4306 chemo disposable pump for Aetna commercial patients? It doesn't matter if authorization is given for either code, they are still denied. We have received denials for both and receive different answers when we call Aetna regarding the denials. Any help will be greatly appreciated.

 

[sls314]

Does anyone know if you use the E0781 chemo non-disposable pump or the A4306 chemo disposable pump for Aetna commercial patients? It doesn't matter if authorization is given for either code, they are still denied. We have received denials for both and receive different answers when we call Aetna regarding the denials. Any help will be greatly appreciated.

According to Aetna's Clinical Policy Bulletin, both codes can be covered when the criteria is met.

The full policy at this link shows the diagnoses and other criteria that Aetna considers medically necessary for coverage:

http://www.aetna.com/cpb/medical/data/100_199/0161.html

 

[dlpirtle]

Thank you Susan