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Aetna to Stop Physical Status Payments

April 15, 2024

According to an April bulletin published by Aetna, the payer will no longer reimburse additional unit value(s) for anesthesia physical status (PS) modifiers, effective July 15, 2024. Aetna gave as a reason for the decision its desire to align with similar Medicare guidelines. It should be noted that this change will only affect Aetna’s commercial plans.

While this announcement has nationwide application, Aetna suggested there could be a different effective date or considerations relative to two different states, as noted below in the following bulletin excerpts:

  • Note to Washington State providers: Your effective date for changes described in this article will be communicated following regulatory review.
  • Note to Texas providers: Changes described in this article will be implemented for fully insured plans written in the state of Texas in accordance with regulatory requirements. Changes for all other plans will be as outlined in this article.

This policy change, which calls for a 90-day advance notice, will no doubt come as another disappointment for anesthesia providers who continue to face new impediments to reimbursement for their services. Please feel free to contact your account executives if you have questions about this announcement.

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