Aetna Expands Telehealth Services to Outpatient Therapy

April 6, 2020
Rick Gawenda

Last week, Aetna announced they were expanding telehealth services to outpatient therapy services until June 4, 2020. That’s the good news! Now for the not-so-good news. Try finding this announcement anywhere on the Aetna website. Lucky for you as a Gold Member, I will give you the step-by-step instructions how to access this announcement from Aetna and get the reference that you need.

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  1. Hello,
    I read the resource pages for Aetna but I didn’t see anything about place of service unless I missed it…..Would it be the telehealth place of service 02?
    Thank you!

    1. Please read the document once you sign into Availity and you will see what CPT codes are allowed and what modifiers are required.

  2. We spoke to a rep in provider services yesterday and they advised our office we would use POS: 11 for Telehealth. You state the same above, but answered “02” to Krista’s 4/6/2020 question. Can you clarify please? I just want to be clear as this is conflicting information. Thanks.

    1. My apologies. I’m writing too many articles. For Aetna, POS code for telehealth would be 02. The APTA has said the same thing on their website.

      1. Completely understandable. However I am still unclear. Aetna told us to use POS “11”. Prefered Therapy providers told us to use POS “11”, and you have said to use POS “02”. Iol. HELP! I need clarity.

        1. I can’t help you anymore than I have already answered in this article. APTA is also saying POS 02 for telehealth.

  3. No coding for 92526 (oral function therapy / swallowing code for speech) or 97530 for OT/PT – any guess on if these two will ever be added?

    1. Read page 1 of the 12 page documented that is available in this article. At the top, it states who it applies to.

      1. I had read it and on page 1 it states:
        All Medical Products (including Commercial & Medicare)

        However, on page 3 it also states: Telemedicine for Medicare Members/Plans:
        Medicare Advantage members may be eligible for telemedicine
        services in accordance with CMS regulations. We follow CMS policy.

        Since CMS has NOT allowed telemedicine for CPT codes 97110 and 97112 (unless performed by a physician) this is clearly a contradiction.
        Please advise. Thank you.

        1. If you have any questions regarding the coverage of telehealth with any insurance carrier and any insurance plan, you as the provider, will need to contact that insurance carrier and ask.

  4. I have been advised through the claims department to ask to be transferred when verifying benefits. The benefits department has been stating that therapy codes (92507, 92526, 97530, 97110) are covered. However, the claims department can fax you over a list of codes that are truly being covered at this time and unfortunately, therapy codes are not on the list.

  5. I’m not sure where your information about billing on a UB04 came from. I have full access to all Aetna materials, and no where does it mention UB04 billing.

    1. Re-read the article and look at Page 1 and who Aetna is addressing the document to. In addition, Aetna advised APTA that telehealth would include the UB-04. As always, contact Aetna if you have questions.

    1. You would need to check with your state practice act, any other state administrative rules and the insurance carrier. If all 3 say yes, then good to go.