Aetna has made some reimbursement changes for mid-level providers and physicians assisting with surgery.
Assistant surgeons
Starting May 1, the reimbursement rate for physicians assisting with surgery will drop from 20 percent of the negotiated rate or recognized charge to 16 percent. It will drop to 8 percent for the second eligible surgical procedure and four percent for each additional eligible surgical procedure.
Mid-level providers
Also, beginning June 1, 2010, nurse practitioners, physician assistants, certified nurse midwives, and registered nurses will receive 85 percent of contracted rates for covered professional services. The rate used to be 100 percent.
The change does not apply to: certified registered nurse anesthetists, registered nurse first assistants, or behavioral health practitioners; claims billed with an assistant surgery modifier; covered DME, orthotics, prosthetics, supplies, drugs, labs, radiology services, and immunizations; private fee-for-service; or provider contracted through a third party or vendor.
In addition, as of July 1, the mid-level provider’s name will need to be in the servicing provider field when submitting a claim. To have the names of mid-level providers added to the Aetna directory, contact your account manager or the provider service center at (800) 624-0756.