Refile Aetna modifier -25 claims back to August 15

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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 article explains a payer update affecting claims involving same-day preventive and problem-oriented evaluation and management services, with attention to Aetna’s stated lookback window for resubmission. It is relevant to medical coders, billers, and practice managers who handle payer denials, documentation review, and timely filing considerations for office and preventive care claims. The article also references Aetna provider communications and the need to confirm that supporting documentation is in place before appealing or resubmitting claims.

Why This Topic Matters

It helps practices identify whether previously denied claims may be eligible for resubmission and understand that payer-specific instructions and documentation expectations can affect payment outcomes.

What You Will Learn

  • The payer policy update discussed in the article
  • The general claim types affected by the update
  • How the article frames resubmission and appeal timing
  • Why documentation review matters for these claims

Who Should Read This

  • Medical coders
  • Medical billers
  • Revenue cycle staff
  • Practice managers
  • Primary care practices

Codes Discussed

Code Ranges Discussed

  • CPT: 9938X, 9939X
  • CPT: 99201–99205
  • CPT: 99211–99215

Modifiers Discussed


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