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Aetna- facet inj

  1. #1
    Talking Aetna- facet inj
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    Has anyone else had issues with Aetna denying cervical and/or lumbar facet joint injections as "experimental/ not medically necessary"? I have reviewed their medical policy, and we are within the parameters. However, EVERYONE we bill lately is denied as "experimental"... any ideas/ thoughts/ suggestions?? thanks.

  2. #2
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    Quote Originally Posted by mattrobin View Post
    Has anyone else had issues with Aetna denying cervical and/or lumbar facet joint injections as "experimental/ not medically necessary"? I have reviewed their medical policy, and we are within the parameters. However, EVERYONE we bill lately is denied as "experimental"... any ideas/ thoughts/ suggestions?? thanks.
    You read this policy, right? http://www.aetna.com/cpb/medical/data/1_99/0016.html

    Make sure you're billing out the correct primary diagnosis code, and if you are, appeal with documentation showing how you met their requirements. You'll have to go back 3 months to show the failed conservative Tx, which may mean getting records from a referring physician, if necessary.

  3. #3
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    yes, that is the medical policy i reviewed.

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