Aetna policy change streamlines payment of modifier 25 claims

In a significant win for DOs and their patients, Aetna has agreed to disable automatic claims denials of E/M services billed on the same day as OMT and appended with modifier 25. The AOA worked closely with our physician liaison at Aetna to implement the change, which allows E/M services billed on the same day as OMT codes 98925-98929 to bypass claims edits that previously triggered the denials. The Maine Osteopathic Association (MOA) also provided important advocacy support. “This change will provide relief for thousands of DOs who’ve been repeatedly penalized by claims denials for appropriately billed services,” said AOA CEO Kevin Klauer, DO, EJD.

The change is effective for services rendered on or after January 1, 2020. For denials prior to this date, the AOA urges members to exercise the right to appeal unfavorable payer decisions. If Aetna rejects a claim for E/M services billed on the same day as OMT and appended with modifier 25 for services provided on or after January 1st, please contact AOA Physician Services for assistance.

For more information, visit the AOA’s Private Payer Advocacy page.