| Procedure |
Effective Date |
Change |
| Per day limits |
3/25/2012 |
Per day limits apply to the following codes effective 3/25/2012:
- 4 units per date of service (2 per side – RT, LT) for:
- L2430 – addition to knee joint, ratchet lock for active and progressive knee extension, each joint.
- 6 units per date of service (3 per side – RT, LT) for:
- L2850 – addition to lower extremity orthosis, femoral length sock, fracture or equal, each.
|
| Flexible fiber optic endoscopic evaluations |
3/25/2012 |
Aetna will allow the professional component (92613, 92615, or 92617) of a flexible fiberoptic endoscopic evaluation when billed on the same date of service as the technical component (92612, 92614 or 92616). |
| 95900 and 95903 – nerve conduction, amplitude and latency/velocity study, each nerve; motor, with/without F-wave study |
3/25/2012 |
95903 will be allowed when billed with 95900. Modifier 59 will override the edit. |
| G0269 – placement of occlusive device into either a venous or arterial access site, post-surgical or interventional procedure (e.g. angioseal plug, vascular plug) |
9/1/2012 |
The placement of an occlusive device/collagen plug is considered incidental to the primary procedure and not separately payable. |
| Arthroscopy |
9/1/2012 |
Modifier 59 will no longer override 29862 and 29863 when billed with 29914, 29915 or 29916. |
| K0739 – repair or non-routine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
9/1/2012 |
K0739 will be allowed 16 times per date of service. |
|
80102 – drug confirmation, each procedure
82145 – amphetamine or methamphetamine
|
2/26/2012 |
The following per day limits apply to the drug screening codes:
- 80102 – 4 units per date of service
- 82145 – 2 units per date of service
|
| Per day limits |
9/1/2012 |
Per day limits will apply to the following codes effective 9/1/2012:
- 2 units per date of service (1 per side – RT, LT) for:
- L8499 – unlisted procedure for miscellaneous prosthetic services.
- 6 units per date of service (3 per side – RT, LT) for:
- L8417 – prosthetic sheath/sock, including a gel cushion layer, below knee or above knee, each.
- A5512 – for diabetics only, multiple density insert, direct formed, prefabricated, each.
- A5513 – for diabetics only, multiple density insert, custom molded from model of patient’s foot, total contact with patient’s foot, including arch, includes arch filler and other shaping material, custom fabricated, each.
|
| Epidurals and transforaminal injections for sciatica and radiculopathy |
9/1/2012 |
Epidurals and transforaminal injections will only be allowed for diagnoses of radiculopathy or sciatica.
Refer to Clinical Policy Bulletin #0722 (Selective Nerve Root Blocks) and #0016 (Back Pain – Invasive Procedures) for more information.
|
| 93975 – duplex scan of arterial inflow and venous outflow of abdominal, pelvic, scrotal contents and/or retroperitoneal organs; complete study |
9/1/2012 |
Aetna considers uterine artery Doppler studies (CPT code 93975) to be experimental and investigational for the assessment of average-risk or high-risk pregnancies. Claims denials may be seen as a result of this policy.
Coverage criteria, including the ineligible diagnosis codes, are in Clinical Policy Bulletin #0088.
|
| 95937 – neuromuscular junction testing (repetitive stimulation, paired stimuli), each nerve, any 1 method |
9/1/2012 |
Aetna considers neuromuscular junction testing as experimental and investigational when billed with the following spinal surgery codes:
- 22010 – 22855
- 62263 – 63746
- 64470 – 64484
- 64561
- 64581
- 64622 – 64627
- 64772
Refer to Clinical Policy Bulletin # 0697 – Intra-operative Monitoring of Electromyography – for more information.
|