Inclusive denials

Hi all,

Aetna insurance frequently denying CPT 81003 or 81002 charges as inclusive with E&M service (99201-99395).
Initially I tried with modifier “25” to E&M, after that I even tried with an appeal, but no use, it denied as inclusive again.

In this case I need clarification that, is there any payer policy in Aetna website regarding this.
Please help me with your opinions and provide me Aetna policies.

Thanks in Advance for your help.



Thanks & regards.
Srinivasarao.b

re: Inclusive denials

That denial is incorrect and has no logic, check your diagnosis code being reported, maybe it is throwing some type of error with their edits. I would contact Aetna’s claims department, and if they can’t help you then contact your provider representative. There may be an error in their edits or a problem with a contract. The denial is not due to an NCCI edit or the test being inclusive with an E/M code.