Aetna - Covid19

Policy Search
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1

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:

2

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

3

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.

Thanks,
Susanne

4

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

5

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.