Aetna Emergency Room Level Of Care Payment Policy

In other cases you should notify your primary care doctor and aetna within 48 hours of an emergency.

Aetna emergency room level of care payment policy. Links to various non aetna sites are provided for your convenience only. Er level of caredecember 1 2016 cpt code 99285 is used to indicate medical conditions that are of high severity are potentially life threatening and require the immediate attention of a physician. You are now being directed to the ama site links to various non aetna sites are provided for your convenience only. You are responsible for any emergency room copay.

Treating providers are solely responsible for medical advice and treatment of members. Any services you receive must be covered under the terms of your aetna plan. This policy does not affect current ed claims processes for aetna s other products including our medicare and commercial plans. And its subsidiary companies are not responsible or liable for the content accuracy or privacy practices of linked sites or for products or services described on these sites.

Although a comprehensive list of the designated minor diagnosis codes has not been made available aetna listed examples of constipation earaches. When seeking emergency care please note that. Aetna went on to state that when a hospital or a physician bills a level 5 emergency room service with a designated minor diagnosis code they will reduce the level 5 to a level 99284 level 4 ed. Services for constipation earaches and colds for example should not be billed using cpt code 99285.

Members should discuss any clinical policy bulletin cpb related to their coverage or condition with their treating provider. Aetna better health has posted a list of auto pay emergency room diagnoses that will.