Aetna has agreed effective August 12 to begin to pay claims for electrocardiograms (CPT code 93010) when billed with evaluation and management (E&M) services (CPT codes 99281-99285), even when billed without a modifier 25.

Physicians will also be able to resubmit previously denied claims for the prior six months (February 10 to August 11, 2006). Physicians have until November 10 to resubmit these claims. Instructions for resubmitting previously denied claims will soon be posted at Aetna’s provider website, http://www.aetna.com/provider.

This victory for physicians nationwide stemmed from a RICO settlement compliance dispute filed by an emergency physicians’ group in North Carolina. CMA commends Aetna for resolving this compliance dispute and going beyond the letter of the settlement agreement to comply with the spirit of the agreement, which is to provide transparency and fairness in its payment practices and other business dealings with physicians.

CMA encourages California physicians to help ensure that Aetna and the other settling health plans keep their promises. If you believe that a health plan is not living up to the terms of its settlement, please contact CMA’s legal department at 415/882-5144 or legalinfo@cmanet.org. The compliance dispute process is simple. CMA, an official signatory medical society on the RICO lawsuits, can assist CMA members and file compliance disputes on their behalf.

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