Aetna and +61795

The Academy has scored another win in private payer advocacy. Late last year, the Academy's Practice Management department was alerted to an impending change in Aetna Policy regarding CPT code +61795 (Stereotactic Computer Navigation). Effective January 2005, Aetna decided to consider +61795 as integral to the primary procedure, and therefore no longer eligible for separate payment. The Academy contested this change in policy with Aetna on the basis of the definition of an add-on code within CPT guidelines and the principles of physician work relative value units. This spring, Aetna reviewed the new policy, and decided to make a change. Effective May 14, 2005, Aetna now considers +61795 to be a separately reimbursable procedure.

If you are encountering and difficulties in getting reimbursed by a third party payer after appealing the denial, please contact the Academy's Practice Management department at 1-877-722-6467 for assistance.