Aetna: Third-Party Claim and Code Review Program

Beginning September 1, 2021, you may see new claim edits. These are part of the Third Party Claim and Code Review Program. These edits support AETNA continuing effort to process claims accurately for commercial and Medicare members. In order to find out if new claim edits will apply to your claim, visit website  Availity.

Example: Urology Policy

Injection of the corpora cavernosa with a pharmacologic agent(s) is performed in the office to assess the patient’s reaction to the drugs, and/or to titrate the proper dosage. The subsequent injections are self-administered by the patient at home and are not reportable. Therefore, Aetna will only allow code 54235 once (1) per 365 days. 
For all coding changes, go to Aetna Payer Space > Resources > Expanded Claim Edits.