Aetna has informed APMA that effective July 23, it will drop its external review program regarding use of the -25 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 -25 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. This notice accompanied their indication that they will also drop external review on use of the -59 Modifier when submitted with the same codes.