Agreement Ends Aetna EKG Payment Dispute

As of Aug, 12, Aetna began paying claims for electrocardiograms (CPT code 93010) when billed with evaluation and management (E&M) services (CPT codes 99281-99285), even without a modifier 25. Previously denied physicians' claims for the prior six months of Feb. 10 to Aug. 12 can be resubmitted for payment until Nov. 10.

Aetna says it will post instructions for resubmitting claims on its Web site .

Aetna agreed to begin paying their claims after North Carolina emergency physicians filed a settlement compliance dispute. They said Aetna was not living up to the terms of the settlement of its part of the federal class action antiracketeering lawsuit against some of the nation's largest for-profit HMOs by TMA and 18 other state medical societies.

TMA General Counsel Donald P. Wilcox, JD, says physicians should pay close attention to the terms of the settlements in the lawsuit and file a compliance dispute if they find that Aetna or any other company involved in the case are not keeping the promises they made when they agreed to change their business practices.

More information about the lawsuit, the HMOs involved, and the compliance process is available at  www.hmosettlements.com .

 


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