Physicians have until July 14 to submit unpaid “add-on” claims to Aetna for adjudication.

As reported previously in Alert, Aetna had been denying claims with add-on codes for CAD mammography (CPT codes 76082 and 76083) and myocardial perfusion testing (CPT codes 78478 and 78480), in violation of its RICO settlement agreement. Some physicians even stopped filing claims because Aetna was not paying them. A number of physicians filed RICO settlement compliance disputes and, as a result, in 2005 Aetna began paying for these add-on codes.

CMA continued to push Aetna to retroactively pay the previously denied claims for add-on codes. As a result of CMA’s repeated complaints, Aetna agreed in April to retroactively pay claims with add-on codes for CAD mammography and myocardial perfusion testing with dates of service on or after January 1, 2004.

The process for resubmitting previously denied claims is described on Aetna’s provider website. Click on “Add-On Code Claims Payment” in the “Features” section in the lower right corner of the top web page. Physicians should submit new claims following standard billing procedures.

More details are available by calling Aetna’s provider service center (888/632-3862 for PPO plans or 800/624-0756 for HMO plans). Have your tax ID number available when you call.

Contact: CMA’s legal information line, 415/882-5144 or legalinfo@cmanet.org.