DecisionHealth, DecisionHealth - 2006 Issue 6 (June)
Aetna to pay for modifier -25, add-on mammography claims
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Article Overview
This premium article covers a payer update from Aetna affecting certain obstetric/gynecologic procedures, evaluation and management billing with modifier -25, and resubmitted mammography add-on claims. It is relevant to coders, billers, practice managers, and compliance staff who need to understand the general scope of the payment issue, the code sets involved, the affected dates of service, and the kinds of claims processing changes Aetna agreed to review.
Why This Topic Matters
Payer-specific payment updates can affect whether claims are paid, resubmitted, or adjusted. Understanding the scope of the article helps billing and coding teams identify whether their services, dates of service, and claim types may be impacted.
What You Will Learn
- The general payer policy issue addressed in the article
- Which service categories were affected by the Aetna update
- How the article frames the handling of certain resubmitted claims and date-of-service considerations
- The coding and billing areas impacted, including evaluation and management and mammography billing contexts
Who Should Read This
- Medical coders
- Medical billers
- Revenue cycle staff
- Practice managers
- Compliance staff
- Obstetric/gynecology billing teams
- Radiology billing teams
Codes Discussed
Modifiers Discussed
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