Aetna
Reimbursement change for mid-level practitioners
Beginning with June 1, 2010 dates of service, Aetna will pay mid-level practitioners at 85 percent* of the contracted rates for covered professional services (consistent with CMS payment policy).
This policy applies to nurse practitioners, physician assistants, certified nurse midwives and registered nurses. As of June 1, you will need to list the mid-level practitioner’s name in the servicing provider field when you submit claims for services rendered by a mid-level practitioner.
This policy does not apply to:
- Certified registered nurse anesthetists, registered nurse first assistants or behavioral health practitioners
- Claims billed with an assistant surgery modifier
- Covered DME, orthotics, prosthetics, supplies, drugs, laboratory, radiology services and immunizations billed by a mid-level practitioner
- Medicare Private Fee-for-Service (non-network based)
- Providers contracted through a third party or vendor
Also, we want to make sure the names of all your practices’ mid-level practitioners display in our directories. For information on joining our network, reference www.aetna.com. For other questions including the process for submitting practitioner contact information, contact your network representative.
*This policy will not apply in the states of Alaska, Kansas, Maine and Missouri.