Aetna to pay for well and sick visits: In policy to start next year, you can bill both with modifier -25

Why This Topic Matters

The article addresses a payer-specific change that can affect how common pediatric and primary care encounters are reported and paid. It also highlights the broader importance of documentation, claim review, and appropriate use of E/M billing in same-day services.

Article Sections

1. Aetna policy change and implementation timing

   Describes the payer’s decision to allow certain same-day service combinations and notes the timing of system changes and non-retroactive implementation.

2. Rationale and payer review considerations

   Summarizes comments from Aetna medical leadership about the policy change, settlement context, and post-payment claim monitoring.

3. Common pediatric encounter scenarios

   Discusses broad pediatric situations involving preventive visits and concurrent illness, including the general documentation themes raised by Aetna representatives.

4. Modifier -25 with well visits: Not for new patients, says consultant

   Covers consultant guidance on distinguishing separate services for new and established patients and the role of documentation structure.