Aetna - Covid19

Here’s the latest on Aetna’s response to Covid19.
In summary,

  • copays and cost sharing is waived for testing and for telemedicine visits (so not copay to collect)
  • until June 4, 2020, in-network providers will be paid for telemedicine; see policy link below for specific codes to use. Most typical codes for pediatricians will be 99421, 99422, 99423, 99441, 99442, 99443
  • behavioral health also covered (see second link below for that policy)

BH policy

For sharing with patients:

If we are in a parity state, do we use the 994… codes or the 99212-99214 codes (as with every other insurer)?

Hi Julie - you would want to code specific to the service. For example, if 99422 is the most applicable code to use, then that’s what you should bill.


If we are seeing them for a normal visit via a live interactive Telehealth platform, would a 99213 be appropriate?

Yes, provided that you are able to appropriately document the components that fall under 99213. For example, if you are not doing at least 2 of these 3 key components:

  • An expanded problem focused history;
  • An expanded problem focused examination;
  • Medical decision making of low complexity.
    but, say, are counseling for Covid19 instead, then you could not use 99213.