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Effective September 1, 2018 venipuncture codes 36415 and 36416 when billed alone by a lab provider will be denied. 

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Allergies update. Effective September 1, 2018 Currently Aetna applies a frequency limit to CPT code 95165, allowing up to 150 units annually in the build-up phase and 90 units in the maintenance phase. Now the same frequency limits will be applied to CPT codes 95120 and 95125. Also, 75 units are allowed annually in the build-up phase and 45 units in the maintenance phase for CPT code 95144. The frequency limits apply per code. 

DEPRESSION SCREENING 

Depression often coexists with other serious illnesses, such as heart disease, stroke, cancer, diabetes, HIV/AIDS and many people do not seek treatment due to various reasons. Aetna offers reimbursement for the depression screening. Check the guidelines: 

  • A provider must be a participating primary care provider or specialty physician, like an OB/GYN physician or internal medicine physician. 
  • A provider must use the PHQ-9 tool to screen patients. 
  • A provider must submit claims using the following billing codes: 
  • CPT code 96127 (brief emotional/behavioral assessment) in conjunction with
  • Diagnosis code Z13.89 (screening for depression) 

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Insights
August 2018