Aetna recently announced that it would stop bundling urinalysis dipstick and pulse oximetry codes submitted with the same date of service as evaluation and management (E&M) codes.

Effective November 12, Aetna will pay for urinalysis dipstick codes (81002 and 81003) and pulse oximetry codes (94760, 94761, 94762) when billed with office-based E&M codes appended with modifier 25. Aetna will also retroactively pay previously denied claims with dates of service on or after May 1. Physicians do not have to resubmit claims.

The changes were recommended by Aetna’s Physicians Advisory Board, which was created as part of Aetna’s RICO lawsuit settlement. Aetna in 2003 became the first HMO to settle with CMA and more than a dozen other state medical associations in CMA’s RICO lawsuit. Since then, six other HMOs have settled the fraud and racketeering cases. CMA filed the lawsuit six years ago, challenging the rapacious tactics of the for-profit managed care industry. The case allowed physicians to air profound grievances against an industry that has unfairly exploited them for more than a decade.

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