Aetna agrees to change its -25 payment policy

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Note:  The following article synopsis was NOT provided by HCPro. It was created by Find-A-Code/innoviHealth.

Article Overview

This piece covers an Aetna claims-payment policy change tied to modifier -25, following a lawsuit settlement involving state medical societies. It is relevant to practices that bill E/M services and want to understand the affected date span, the categories of procedures involved, and the payer’s interim handling of denials while system edits are updated.

Why This Topic Matters

Practices with Aetna in their payer mix may need to review past and current E/M claims impacted by this policy change, especially while automated edits and manual reprocessing are being updated.

What You Will Learn

  • What the article says about Aetna’s modifier-25 payment policy change
  • Which broad types of services were included in the affected claim review
  • How the article characterizes the timing of claim reprocessing and system edits
  • What payer and professional-society actions prompted the policy change

Who Should Read This

  • Medical coders
  • Billing staff
  • Revenue cycle teams
  • Practice managers
  • Compliance staff

Codes Discussed

Code Ranges Discussed

  • CPT: 70140–70160
  • CPT: 70200–70220
  • CPT: 71100–71110
  • CPT: 72010–72052
  • CPT: 72070–72080
  • CPT: 72192–72194
  • CPT: 73000–73040
  • CPT: 73060–73080
  • CPT: 73120–73200
  • CPT: 73500–73520
  • CPT: 73550–73565
  • CPT: 73590–73610
  • CPT: 73620–73700
  • CPT: 74000–74170
  • CPT: 90780–90784
  • CPT: 94656–94667
  • CPT: 96110–96115
  • CPT: 96150–96152
  • CPT: 97802–97804
  • CPT: 99354–99359
  • HCPCS LEVEL II: G0245–G0247

Modifiers Discussed


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