decisionhealth Newsletters, Part B News - 2022 Issue 3 (March)
Aetna closes the door on office consults
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Article Overview
This article reviews Aetna’s decision to stop paying office consultation claims, describes how the change fits into a longer trend among private payers, and notes related CPT Editorial Panel activity affecting consultation and evaluation and management code categories. It is relevant to coders, billing staff, compliance teams, and practices that need to track payer coverage changes and understand how they affect reimbursement policy.
Why This Topic Matters
Coverage changes for consultation services can alter claim submission strategy, payer-specific billing workflows, and revenue expectations. The article helps readers track a major payer policy update and the related national coding landscape that may influence how consultation services are handled.
What You Will Learn
- How one major payer change fits into broader consultation coverage trends
- What national coding updates are being discussed for consultation-related E/M services
- Why consultation coverage remains an operational issue for medical practices
- How payer policy uncertainty can affect claims processing and billing planning
Who Should Read This
- Medical coders
- Billing specialists
- Revenue cycle staff
- Compliance teams
- Practice managers
- Physician offices
Codes Discussed
Code Ranges Discussed
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