Aetna has informed APMA that effective July 23, it will drop its external review program regarding use of -59 Modifier when submitted with CPT 11719-11721, G0127, and 11055-11057.
This development follows more than two years of APMA’s advocacy through multiple communications and meetings with Aetna leadership.
Aetna had been inappropriately applying an edit to certain foot care claims. APMA’s Health Policy Committee formed a 59 Modifier workgroup more than two years ago to address this issue. Thanks to the work of that group, other APMA members, staff, and consultants all contributed to this latest victory.
APMA encourages members to continue to follow NCCI guidelines and only submit callus paring codes when the calluses pared are not on the same distal phalanx of a toe that had a nail debrided. Members can learn more about how to lower the chances of denials related to the 59 Modifier by reviewing APMA’s -59 Modifier Claims Tool Kit.