Just got notice from my IPA that Aetna will pay for a two part telehealth well, they are asking us to code a 99212-14 for the initial TH portion, then use well visit code for in person visit. Has anyone else gotten this information? And if so, any idea what diagnosis to use for the initial TH portion (or will they accept two well visit dx over two different visits)
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Our billing staff is telling us that Aetna our only payor that will not pay for well care. If you get anything in writing, can you please post it! United is now paying for virtual well care!
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Yes, please post anything in writing from the company.
We got word from our billing service that Aetna is covering TM wells but nothing about a 2-part visit. Just started ~2wks ago. Too early to see payment yet…
Aetna informed us of the same thing today, they want us to code a 99212-99214 for the telehealth portion and then use the well code for the in person visit as well.
Also, I asked about the diag code and he said use the same Z code for both visits!
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I was given the same information today. We were instructed to use a well diag for both visits.
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Does anyone have any information about Medicaid HMO’s paying for virtual wellness checks?
In Mass we are part of a Medicaid ACO that is reimbursing for virtual well visits.
This may be old news, but I never saw the policy explicitly written until now. Posted last week.
From aetna website
Will Aetna allow wellness visits to be rendered through telemedicine during the COVID-19 public health emergency?
Aetna will cover appropriate evaluation and management codes with a wellness diagnosis for those aspects of the visit done via telehealth. Preventative visit codes should be reserved for such time when routine in-office visits resume and the remaining parts of the well visit can be completed. Both services will be fully reimbursed, and the patient will not incur a cost share.
Still leaves some messy questions like “is this retroactive, how do you code a 9921X without a “problem”, which visit will determine next year well check timing, what if families refuse to come back… how are HEDIS measures affected, ect.”
Medicaid HMO’s are not covering Virtual Wellness checks in GA. I inquired and finally received an Email from Peachstate which now includes Wellcare stating that. Of course, there’s Amerigroup and CareSource and no coverage from them either.
Hopefully, this will change…
Thanks @val
In NJ, BCBS, UHC and Aetna WILL NOT pay for TM as early as next week, Cigna will stop in July. Planning on charging straight out-of-pocket fee for sick and WCC TM visits… will see what happens. Many families do not know how difficult it is to get reimbursed for usual in office visits, much less TM. I expect push negative feedback from families.
Perhaps it’s time to take to social media and let the world (not just your families) know.
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Anyone in the forum who runs a concierge practice? I am tired of the fights with insurance companies… tired of not getting paid enough, of negotiating on behalf of families who themselves do not want to pay their balances or copays, tired of buying vaccines upfront. Most of us pediatricians already provide “concierge services” at insurance prices. Not fair. Can you share your experiences? Thanks!