Wiki Modifiers and Insurance companies

[adunlap23]

Good morning,
As a new coder, I am finding it difficult to find information on individual insurance companies and their policies on modifiers. I have referenced cms.gov but their rules seem general and I have found not every insurance company follows their guidelines. I have learned from other coders that most insurance companies do not accept modifier 51. My question is, where do they find that information? I am recently looking into Aetna, but their website seems to be dictated more towards patients so I don't know where to find their policies regarding modifiers and cpt codes.
I appreciate all the help I can get!

 

[rattyvonratkins]

Aetna Medicare? Commercial Aetna? Aetna Medicaid? A lot of times when searching for insurance policies, Google is your best friend. Quite often, searching for "BCBS + modifier + 51 + policy" (for example) might turn up relevant results. Or if nothing worthwhile comes up, try wording it different ways, like "BCBS + multiple + procedures + policy."

Aetna has their provider manual online which is easy to find, but a lot of their policies are on Availity so Google probably won't help you in that regard.
Are you signed up for Availity? If so, go to Payer Spaces -> Aetna -> Resources, which has a search bar you can type into.
I attached their policy on Multiple Procedures, although it isn't entirely helpful since it doesn't explicitly say whether mod 51 is needed or not. But it sounds like they'll reduce payment on multiple procedures with OR without mod 51 to me, so it probably isn't necessary. Just my interpretation anyway.

 

[sls314]

Good morning,
As a new coder, I am finding it difficult to find information on individual insurance companies and their policies on modifiers. I have referenced cms.gov but their rules seem general and I have found not every insurance company follows their guidelines. I have learned from other coders that most insurance companies do not accept modifier 51. My question is, where do they find that information? I am recently looking into Aetna, but their website seems to be dictated more towards patients so I don't know where to find their policies regarding modifiers and cpt codes.
I appreciate all the help I can get!

Aetna's website is one of the best when it comes to resources and look up tools for providers. Where are you looking that you're only finding patient related information? Just the general aetna.com?

You have to go to the provider section of the website: https://www.aetna.com/health-care-professionals.html

The key to finding the relevant information on a payer website is to go directly to the site's menu for providers. Pretty much all of the major insurers have a menu where you can click on "for patients" or "for providers."

Stay current on the provider manuals and provider newsletters - many big payers will send out e-mails notifying of any provider/reimbursement policy updates. Get on those email lists as well.

 

[adunlap23]

Yes, I was just on the general website. I did find the provider section after I posted my question. Your suggestion to read up on the newsletters and join the e-mail list is a great idea. I'm going to do that now. Thank you for your help!