MSDC Important Message Regarding Payment of Aetna Add-On Code Claims

Aetna and representatives of various state medical societies have reached agreement settling a dispute about the payment of claims for certain "add-on codes."

Under the terms of a lawsuit settlement agreement dated May 21, 2003, Aetna agreed to pay add-on codes from the date they became effective under CPT®.  Section 7.20(b) (ii) of the agreement states the following:  "'Add-on' codes, as designated by CPT, shall be recognized and eligible for payment as separate codes and shall not be subject to Multiple Procedure Logic."  Aetna's systems did not recognize certain codes related to CAD Mammography Services (CPT Codes 76082 & 76083) and Myocardial Perfusion Testing Services (CPT Codes 78478 & 78480) and as a result, these claims were denied.  Numerous physicians filed compliance disputes regarding these codes.  Aetna has since changed its systems so the CAD Mammography add-on codes have been recognized since April 1, 2005 and the Myocardial Perfusion Testing add-on codes since May 13, 2005.

During the period of April 17, 2006 through July 14, 2006, Aetna will process resubmitted or new claims related to:

*CAD Mammography Services (CPT Codes 76082 & 76083) provided to Aetna members between January 1, 2004 and March 31, 2005; and/or *Myocardial Perfusion Testing Services (CPT Codes 78478 & 78480) provided to Aetna members between January 1, 2004 and May 12, 2005.

Timely filing and appeal deadlines will be waived.  Late interest and penalty payments will not apply to these claims. Please note that all other policies will still apply and may impact the ultimate payment of the code(s).

Aetna has posted key information, instructions and forms on www.aetna.com on the "Doctors & Hospitals" main page under "Features" in the lower right corner.  Simply click the link titled "Add-On Codes Claims Payment" to access the information.  A link will also be posted on the "Claims" main page of the secure provider website.  Physician practices can resubmit previously denied claims by listing these claims on spreadsheets and submitting them to Aetna via secure e-mail.  New claims can be submitted electronically or via paper, using current standard procedures. Also see http://www.aetna.com/provider/addon_claims_payment.html for detailed information.

For further information about the submission of these claims, or if you are unable to submit via www.aetna.com, please call the Aetna Provider Service Center at 888-632-3862 for Indemnity and PPO-based benefits plans or 800-624-0756 for HMO benefits plans.