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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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