Aetna updates laminotomy/laminectomy payment policy; considers additional edits


Aetna issued a coverage policy update for laminotomy with arthrodesis procedures and continues to consider additional edits for upcoming policy revision, according to a letter from North American Spine Society President F. Todd Wetzel, MD.

Aetna's new policy states: "We'll no longer allow modifier – 59 to override the incidental denial of codes 63030, 63042, 63047 or 63048 when billed in conjunction with code 22632.


"We'll add incidental denials of laminotomy/laminectomy codes 63030, 63042, 63047 and 63048 when billed with arthrodesis codes 22633, 22634 or 22612 and restrict modifier – 59 from overriding these edits."


The changes went into effect on Sept. 1. Since then, the NASS Health Policy team shared concerns with Aetna's medical policy team, and Aetna is considering additional edits for upcoming policy revisions. According to NASS, the edits include discontinuing coverage denials for:


• Laminectomy codes with 22612, the standard posterior fusion code
• Laminectomies at other levels performed with interbody fusions


Aetna offers physicians the opportunity to appeal denial decisions, and the coverage team will review and update accordingly. "We are very appreciative of Aetna's efforts and support in addressing this important issue and ask you to join us in celebrating one more step toward helping our patients access appropriate spine care," wrote Dr. Wetzel.


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