Aetna Changes Modifier 25 Policy

Aetna and representatives from several state medical societies reached an agreement whereby Aetna will reimburse physicians separately for specific procedures billed with an Evaluation and Management (E&M) code appended with Modifier 25. All other policies will still apply and may impact the ultimate payment of the codes. These policies can be found on our secure provider website. Once logged in, registered users should select “Doing Business with Aetna,” “Policy Information,” then “Payment and Coding Policies” to view these policies.

Physicians do not need to resubmit claims, and no further action is needed on their part.

Aetna will reprocess previously denied claims with dates of service dating back to July 1, 2004 for specific procedures billed with an E&M code appended with Modifier 25.

As a permanent solution, Aetna is updating its IT systems so when these specific procedure codes are billed with an E&M code appended with Modifier 25, both codes will be paid.

To expedite payment until the system fixes are complete, physicians may append Modifier 59 to the specific procedures billed with an E&M code. This will speed up payment. Physicians can continue to use Modifier 25, but it will take Aetna a little longer to reprocess those claims.

We believe that health care professionals will see this as further evidence of Aetna's commitment to a collaborative relationship with the medical community.