Marilyn Posted Wed 25th of June, 2014 11:25:39 AM
Aetna only allows "4" units for procedure code "97802". Initial visit, we bill for "6" units. Need help if we need to use a modifier "59" or one that's applicable for the other 2 units.
Also, for future billing, would this be correct?
SuperCoder Answered Wed 25th of June, 2014 12:17:18 PM
Thanks for your question. Per Aetna's billing policy for 97802, only 4 units are allowed per day for this service. If you were to bill an additional 2 units it would still deny because only 4 units are allowed per day. Since this is their specific policy, I would suggest that you contact Aetna to find out if you can appeal their decision with documentation.
See link below: