<> Loan; Lines of Credit; Home Equity Loans & Lines of Credit; New & Used Vehicles; Connect With Us. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this product. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. However, certain holistic and experimental treatments that are backed up by scientific study may potentially be covered by Aetna. Any use of CPT outside of Aetna Clinical Policy Bulletins (CPBs) should refer to the most current Current Procedural Terminology which contains the complete and most current listing of CPT codes and descriptive terms. that lets you know how much coverage your plan gives for various treatments. It is used to treat many conditions, including: Research has shown that TMS can be especially useful for cases of depression and OCD that are not responding well to medication. Find a Medication for 2022 High Value Plan | Aetna WebH0032 Mental Health Service Plan Development by non-physician Event $ 134.72 $ 89.24 $ 91.92 $ 84.00 $ 84.00 $ 89.24 $ 89.24 Aetna Better Health of Kentucky Community Mental Health Center (CMHC) Fee Schedule H2011 H0031 H2019 Aetna Better Health of A member with an ACO arrangement will have a member ID card with an ACO logo and/or network name. It will show you whether a drug is covered or not covered, but the tier information may not be the same as it is for your specific plan. In addition, coverage may be mandated by applicable legal requirements of a State or the Federal government. WebFee Sum of Anaesthetist Fee 17170 Professional attendance on (initiation of care of) patient requiring intensive care in an emergency up to 2 hours 0 197 17180 Professional attendance on (initiation of care of) patient requiring intensive care in an emergency 2-3 hours 0 303 While the Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. The conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered (i.e., will be paid for by Aetna) for a particular member. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. The April 1, 2021 ASC Fee Schedule is available and can be downloaded using the links provided here. Pulse TMS is currently open and following CDC guidelines for protection of our staff and patients. And you don't want to pay more than you have to. WebOnce all of your healthcare costs for the year reach the deductible amount, Aetna will cover the rest of your care. These plans are not considered to be qualified health plans under the We can assess your situation, recommend a TMS therapy schedule for you, and talk to Aetna about covering your costs. Schedule Each main plan type has more than one subtype. Go to the American Medical Association Web site. , talk therapy is the starting point. While Clinical Policy Bulletins (CPBs) define Aetna's clinical policy, medical necessity determinations in connection with coverage decisions are made on a case by case basis. In addition, a member may have an opportunity for an independent external review of coverage denials based on medical necessity or regarding the experimental and investigational status when the service or supply in question for which the member is financially responsible is $500 or greater. <> While Clinical Policy Bulletins (CPBs) define Aetna's clinical policy, medical necessity determinations in connection with coverage decisions are made on a case by case basis. After entering basic patient and claims information, the cost estimator uses your fee schedule and your patients' benefits plans to: Show you our estimated payment to you. Members and their providers will need to consult the member's benefit plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply. Contracted physicians can access fee schedules online on our secure provider website. The coverage described in this schedule of benefits will be provided under the Customer's group plan. Treating providers are solely responsible for medical advice and treatment of members. The discounts are available through participating healthcare providers Email Us [email protected] Find A Location. Any use of CPT outside of Aetna Clinical Policy Bulletins (CPBs) should refer to the most current Current Procedural Terminology which contains Copyright 2015 by the American Society of Addiction Medicine. If your hospital is reimbursed Aetna Please note also that the ABA Medical Necessity Guidemay be updated and are, therefore, subject to change. 15 0 obj The AMA disclaims responsibility for any consequences or liability attributable or related to any use, nonuse or interpretation of information contained in Aetna Clinical Policy Bulletins (CPBs). For most mental health coverage, the first type of approval you need is a referral. Q. There are a few different treatment approval methods used by Aetna. In addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members. Policies provide maximum benefits when market. Members should discuss any matters related to their coverage or condition with their treating provider. Call Member Services at 1-877-238-6200. with us to see if Aetna will help pay for your TMS treatments. The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. WebTo provide reimbursement guidelines for Aetna Better Health of Louisianas Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) preventive service[NS2] program requiring that health care services are available and accessible to applicable Members and which assists and encourages parents or guardians of eligible children, including 2023 . They have an. This search will use the five-tier subtype. Non-network providers are reimbursed at traditional fee schedules. While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. In case of a conflict between your plan documents and this information, the plan documents will govern. Please be sure to add a 1 before your mobile number, ex: 19876543210, Deliver estimates of patient copayments, coinsurance and deductibles, Help you initiate financial discussions with patients prior to, or at the time of care, Reduce, and potentially eliminate, financial surprises for you and your patients. Cost-share is waived through at least May 11, 2023. Since Clinical Policy Bulletins (CPBs) can be highly technical and are designed to be used by our professional staff in making clinical determinations in connection with coverage decisions, members should review these Bulletins with their providers so they may fully understand our policies. endobj WebThe information, tools, and resources you need to support the day-to-day needs of your office July. All Rights Reserved. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. For language services, please call the number on your member ID card and request an operator. This information is neither an offer of coverage nor medical advice. Aetna has reached these conclusions based upon a review of currently available clinical information (including clinical outcome studies in the peer-reviewed published medical literature, regulatory status of the technology, evidence-based guidelines of public health and health research agencies, evidence-based guidelines and positions of leading national health professional organizations, views of physicians practicing in relevant clinical areas, and other relevant factors). Aetna Inc. and its affiliated companies are not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites. Members and their providers will need to consult the member's benefit plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply. CPT is a registered trademark of the American Medical Association. The ABA Medical Necessity Guidedoes not constitute medical advice. Note that physician fee schedule information will not display accurate rates for care services provided to Aetna members who participate in an accountable care organization {ACO) arrangement. You will receive the discount off the providers usual and customary WebFor requests of eleven or more codes, you can enter the codes on an Excel spreadsheet (include tax ID, contact telephone number, CPT codes and modifier) and use the FeeSchedule@Aetna.com email address to send it to us.