Issue: Aetna was not paying CPT code 93010 when billed with an E&M code (CPT Codes 99281-99285) appended with a -25 modifier as required by the settlement. However, because Medicare and some other payers do not require the -25 modifier to be paid, many physicians submitted their claims without a modifier and therefore this code combination was considered separately.
Resolution:
Aetna reprocessed physicians’ claims for dates of service back to July 1, 2004 as a result of resolution of the general modifier -24 dispute.
Aetna removed the edit entirely effective Aug .12, 2005, meaning that Aetna has started paying for both CPT code 93010 and an accompanying E&M code (CPT 99281 – 99285) without the need for physicians to append a -25 modifier.
Physicians had the opportunity to resubmit claims billed without the -25 modifier back to Feb. 10, 2006. Aetna’s voluntary agreement to do this goes further than required by the settlement agreement.
