Game Plan & Strategy: Aetna Update November 2023
Aetna is one of the top 10 largest health insurance payors in the country
Alert:
15% reduced payment for PTA services delayed until March 1, 2024.
Non-Covered PT Telehealth services:
group therapy
high complexity evaluations
re-evaluations
wheelchair assessment
biofeedback training
orthotic management and training
audio-only services for self-care home management/ADL and safety procedures
Covered PT telehealth services (with the GT or 95 Modifier):
ther-ex
neuro re-education
low & moderate evaluations
ther-act
physical performance testing
community/work reintegration
assessment of assistive technology use
orthotic management/training
prosthetic training.
Solution:
PTs should continue to provide appropriate level care for telehealth services through HIPAA approved technology and avoid non-covered services, which typically require additional visual, manual, and other higher level critical analysis often provided during in-person treatments. Don’t forget to check with your state-practice act on licensure limitations that may have changed since the end of the public health emergency.
Other References:
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