Aetna Exempts OMT Codes from Prior Authorization Policy

Effective August 1, 2019, OMT CPT codes 98925-98929 are exempt from Aetna’s prior authorization requirements. Aetna made the announcement to AOA leadership during a conference call earlier this week and highlighted the collaborative efforts of the AOA and the impacted state affiliates, which includes Pennsylvania, as a major factor in their decision.

 “This change eliminates a barrier to safe, effective relief for patients seeking treatment for musculoskeletal pain, reflecting the understanding that pharmaceuticals shouldn’t be the only option physicians can immediately provide. AOA appreciates Aetna’s recognition of the value of osteopathic care and its decision to reduce administrative burden for DOs who perform OMT,” says AOA President Ronald Burns, DO, FACOFP.

Please note Aetna and National Imaging Associates (NIA) are still working to update their websites and CPT code matrix documents. To view Aetna’s statement on this issue, please click here.

If you received claims denials for CPT codes 98925-98929 citing no prior authorization as the reason for the denial yet have documentation showing you attempted to complete or completed the process, please contact National Imaging Associates at 866.842.1542. This applies to OMT services provided from 9/1/18 – 7/31/19 for DE, NY, PA, and WV and from 1/1/19 – 7/31/19 for NJ.

The AOA Physician Services Department is available to answer questions at 1-888-626-9262 or email [email protected].