Aetna is now accepting resubmissions of previously denied claims for E&M services provided on the same day as a decision for surgery with dates of service between January 1, 2005, and February 11, 2006.

Aetna in 2005 announced that it would begin reimbursing physicians for E&M services when billed with modifier 57, performed on the same day as a decision for major surgery (global, 90-day procedure). Implementation of this policy change was delayed and Aetna's claims processing systems finally began recognizing E&M Codes with these modifiers effective February 11, 2006. At that time, Aetna also announced that previously denied claims with dates of service of August 15, 2005, to February 11, 2006, could be resubmitted.

This policy change was recommended by Aetna's Physicians Advisory Board, which was created as part of Aetna's RICO lawsuit settlement. A recently resolved RICO settlement compliance dispute has increased the number of claims eligible for retroactive reconsideration. Previously denied claims with dates of service back to January 1, 2005, can now be resubmitted. The resubmission period is January 1 to April 30, 2007.

Click here for instructions on resubmitting claims to Aetna.

More information is available in the RICO Resource Center.

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