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AETNA

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?
97802-25x2 units
97802-59x2 units?

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:
https://www1.aetna.com/provider/data/OLU_SE_SEPT2011.pdf

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