Medicare Advantage Policy vs Medicare Policy Viscosupplementation

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I am looking for any assistance in this matter.

I have a Medicare Advantage plan (AETNA Medicare) who is telling me that fluoroscopy is not covered with joint injections involving Viscosupplementation stating that is not clinical evidence for this and it is investigational. This is a new change to their Policy. Medicare (and every other health plan) does cover fluoroscopy when billed with viscosupplementation. I have appealed this with AETNA with documentation from the provider that it is medically necessary to locate the area to inject the viscosupplementation into as well as noting the Medicare policy. They have of course upheld their denial.

My questions is: Do the Medicare Advantage policy have to follow Medicare? And is there any documentation I can provide showing this? Is there someone in Medicare that I can contact?

We do this type of procedure quite often and fluoroscopy has a high reimbursement.

Thank you in advance for any help!

Melissa Harris, CPC
 
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