Aetna 97140 Policy Update

A few months ago, Aetna released a new policy indicating they will no longer pay for 97140 (manual therapy techniques) when performed on the same date of service as a CMT code (9894x). This even includes billings where the provider appends the -59 modifier (appropriately or inappropriately). Representatives from the American Chiropractic Association (ACA) met with Aetna and were told the policy change was based on Aetna’s belief that many doctors were inappropriately appending the -59 modifier even when the service was performed on the same region that was adjusted.

Results

As a result of ACA’s discussions with Aetna, the ACA released the following information: “After further discussion, ACA and Aetna reached a mutually beneficial solution allowing documentation to be submitted with the initial claim for review, so that there is no need for denial – a true example of successful cooperation between ACA and insurance companies. In this way, both Aetna and providers only handle the claim once.

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At this time, Aetna has changed its computer system to allow for documentation to be submitted on medically necessary claims that demonstrate that 97140 was performed on the same date of service as CMT and that 97140 was performed in a region other than the region in which the CMT was performed. Aetna has overridden its systems to make this a manual process, so it is possible that a few claims may process in the former manner while claims departments become accustomed to this new system. If any claims are denied, they should be appealed with documentation and sent to the local Aetna Appeals Center (not the Claims Center).”

The ICS disagrees with Aetna’s policy. However, we are grateful to the ACA for making progress on this issue with Aetna so that our members have a way of being fairly reimbursed when performing CMT and manual therapy in different regions.