Evaluation and Management Services Payment Policy

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As per Aetna, Last June, we notified you of changes to our policy for payment of E&M services for non-physicians to include behavioral health non-physician providers. We postponed that change.

Effective November 1, 2017, we will not pay for E&M codes (99201 – 99499) for the following behavioral health non-physician providers:

  • Alcohol and drug counselors
  • Behavioral analysts
  • Employee assistance program (EAP) counselors
  • Licensed professional counselors
  • Marriage and family social workers
  • Other mental health counselors
  • Registered social workers

We will continue to reimburse for:

  • 99408: Alcohol and/or substance (other than tobacco) abuse structured screening (for example, AUDIT, DAST) and brief intervention (SBI) services; 15 – 30 minutes
  • 99409: Alcohol and/or substance (other than tobacco) abuse structured screening (for example, AUDIT, DAST) and concise intervention (SBI) services; higher than 30 minutes.

We are also expanding the policy, effective September 1, 2017, and will not reimburse the following medical non-physician providers for E&M services:

  • Opticians
  • Massage therapists
  • Respiratory therapists

All professionals mentioned in this update should review the CPT, and Healthcare Common Procedure Coding System (HCPCS) national code sets to pick a more accurate code that describes the services they are rendering. 

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