Effective 05/01/2017 Aetna Better Health of Ohio will change the way unlisted and non-specific CPT and HCPCS codes are reviewed and paid.

With a few exceptions listed below, these codes will no longer be managed through the prior authorization process. They will be managed with Medical Records at the time of claim submission. That is, records supporting the use of these codes must be submitted with the claim. These claims will pend to review for:

Codes Not Included in the Process Change Are:

Code(s)	Process
41899 - General Anesthesia for dental procedures	Prior Authorization
E1399 and K0108 - wheelchair components and services	Prior Authorization
90999 - unlisted dialysis procedure	Prior Authorization with dialysis services
Unlisted J code	Prior Authorization

If records are not submitted with any claim including one of the codes listed below, the claim will be denied for lack of documentation. You may resubmit the claim with required supporting records.

Sincerely,
 

Provider Services

Aetna Better Health of Ohio