Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. If you have questions, reach out to your HR benefits manager. Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. You are leaving our Medicare website and going to our non-Medicare website.If you do not intend to leave our site, close this message. In addition, a member may have an opportunity for an independent external review of coverage denials based on medical necessity or regarding the experimental and investigational status when the service or supply in question for which the member is financially responsible is $500 or greater. Access your health information, lab results and personalized tips from anywhere with your health dashboard. I may or may not be employed by an Aetna-contracted provider. Members should discuss any matters related to their coverage or condition with their treating provider. The member's benefit plan determines coverage. 1-800-358 If youd like to learn more about Aetna Medicare plans, explore our product page for detailed information. *Phone number. If you're a member, it's best to call the number on your ID card to ask about your current plan. Others have four tiers, three tiers or two tiers. Send us an email and well get back to you as soon as possible. You are now being directed to the CVS Health site. *First Name. Members should discuss any Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider. Please note also that Dental Clinical Policy Bulletins (DCPBs) are regularly updated and are therefore subject to change. Aetna's conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered (i.e., will be paid for by Aetna). And you'll have a partner to help you manage your health every step of the way. Treating providers are solely responsible for medical advice and treatment of members. The discussion, analysis, conclusions and positions reflected in the Clinical Policy Bulletins (CPBs), including any reference to a specific provider, product, process or service by name, trademark, manufacturer, constitute Aetna's opinion and are made without any intent to defame. Applicable FARS/DFARS apply. This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. When you need care for minor illnesses or injuries, you dont have time to wait. The five character codes included in the Aetna Clinical Policy Bulletins (CPBs) are obtained from Current Procedural Terminology (CPT), copyright 2015 by the American Medical Association (AMA). The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. The ABA Medical Necessity Guidedoes not constitute medical advice. In the event that a member disagrees with a coverage determination, member may be eligible for the right to an internal appeal and/or an independent external appeal in accordance with applicable federal or state law. Our plan selection pages will be down for maintenance starting Friday, April 16, at 9 p.m. and returning by 1 p.m. Saturday, April 17. Aetna defines a service as "never effective" when it is not recognized according to professional standards of safety and effectiveness in the United States for diagnosis, care or treatment. Send us an email and well get back to you as soon as possible. CPT is developed by the AMA as a listing of descriptive terms and five character identifying codes and modifiers for reporting medical services and procedures performed by physicians. Please contact Medicare.gov or 1-800-MEDICARE (TTY Users should call 1-877-486-2048) 24 hours a day/7 days a week to get information on all of your options. ", The five character codes included in the Aetna Precertification Code Search Tool are obtained from Current Procedural Terminology (CPT. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. Go to the American Medical Association Web site. Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. Licensed mental health counselors are ready to talk with you about your mental health too because we care about your whole health, stress, depression, anxiety, all of it, with virtual appointments available seven days a week. Aetna handles premium payments through InstaMed, a trusted payment service. If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. The information you will be accessing is provided by another organization or vendor. Why choose ${company} Medicare Solutions? Others have four tiers, three tiers or two tiers. To help us direct your question or comment to the correct area, please select a category below. Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search. Disclaimer of Warranties and Liabilities. Well need to terminate your existing agreement with us. Members and their providers will need to consult the member's benefit plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply. It's easy to update a provider address, phone number, fax number, email address or initiate an out-of-state move or a change in provider group. The information you will be accessing is provided by another organization or vendor. Whether youve come down with a cold or need mental health counseling, CVS Health Virtual Care makes it simple. Get started with Teladoc Health through the Aetna HealthSMapp. Please contact Medicare.gov or 1-800-MEDICARE (TTY Users should call 1-877-486-2048) 24 hours a day/7 days a week to get information on all of your options. You cant trust caller id. However, applicable state mandates will take precedence with respect to fully insured plans and self-funded non-ERISA (e.g., government, school boards, church) plans. Aetna members have access to contact information and resources specific to their plans. Report the call. Have questions about our products, policies and services? (sneezes) Bless you. [Narrator]Your child has an earache at 2:00 AM? The information you will be accessing is provided by another organization or vendor. We'll try our best to get back to you within 24 hours. CPT is a registered trademark of the American Medical Association. Members and their providers will need to consult the member's benefit plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply. The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. New and revised codes are added to the CPBs as they are updated. This information is neither an offer of coverage nor medical advice. Health benefits and health insurance plans contain exclusions and limitations. If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. You, your employees and agents are authorized to use CPT only as contained in Aetna Clinical Policy Bulletins (CPBs) solely for your own personal use in directly participating in healthcare programs administered by Aetna, Inc. You acknowledge that AMA holds all copyright, trademark and other rights in CPT. Links to various non-Aetna sites are provided for your convenience only. The term precertification here means the utilization review process to determine whether the requested service, procedure, prescription drug or medical device meets the company's clinical criteria for coverage. Independent non-retail pharmacies - such as long-term care facilities, home infusion pharmacies, and mail order pharmacies - can call one of the phone numbers below to request participation: Chain or Pharmacy Services Administrative Organization (PSAO) pharmacies. Disclaimer of Warranties and Liabilities. Members should discuss any matters related to their coverage or condition with their treating provider. Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. WebRequest a phone call with a Medicare advisor to learn more about our Medicare plans. CPT only copyright 2015 American Medical Association. Under certain plans, if more than one service can be used to treat a covered person's dental condition, Aetna may decide to authorize coverage only for a less costly covered service provided that certain terms are met. In the event that a member disagrees with a coverage determination, member may be eligible for the right to an internal appeal and/or an independent external appeal in accordance with applicable federal or state law. Got a rash and not sure what it is? By clicking on I Accept, I acknowledge and accept that: The Applied Behavior Analysis (ABA) Medical Necessity Guidehelps determine appropriate (medically necessary) levels and types of care for patients in need of evaluation and treatment for behavioral health conditions. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Complete this form to request our representatives visit you at home to discuss the Aetna Medicare Advantage plans available in your area. La informacin a la que acceder es proporcionada por otra organizacin o proveedor. Applicable FARS/DFARS apply. We received your request, and well get back to you shortly. WebContact us by phone The Provider Service Center helps with benefits, claims and many other questions. *Zip code. CPT only copyright 2015 American Medical Association. ", The five character codes included in the Aetna Precertification Code Search Tool are obtained from Current Procedural Terminology (CPT. The AMA disclaims responsibility for any consequences or liability attributable or related to any use, nonuse or interpretation of information contained in Aetna Clinical Policy Bulletins (CPBs). The discussion, analysis, conclusions and positions reflected in the Clinical Policy Bulletins (CPBs), including any reference to a specific provider, product, process or service by name, trademark, manufacturer, constitute Aetna's opinion and are made without any intent to defame. Do not give out your Aetna member ID number or other personal information. Call 1-800-556-1555 (TTY: 711) anytime. Call 1-855-835-2362to speak with a licensed Teladoc Health provider in minutes.*. This site has its own log in. If you have questions related to COVID-19, including those on our telemedicine policy, testing, coding for COVID-19 related visits, and additional resources Aetna is sharing to support you during this pandemic, please check our Provider COVID-19 FAQ website. WebUSA. Call a licensed agent at ${dynamicPhone} (TTY: 711),${hours}. Links to various non-Aetna sites are provided for your convenience only. If you do not intend to leave our site, close this message. In addition, a member may have an opportunity for an independent external review of coverage denials based on medical necessity or regarding the experimental and investigational status when the service or supply in question for which the member is financially responsible is $500 or greater. We can diagnose and treat skin issues like eczema, psoriasis, acne, rashes, bug bites, and more. Whether you need help managing your chronic condition, or are looking to schedule a wellness visit, CVS Health Virtual Primary Care makes it simple. Treating providers are solely responsible for dental advice and treatment of members. Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. When billing, you must use the most appropriate code as of the effective date of the submission. The home visits conducted by Medicare Advantage plans allow for the capture of more diagnoses, which in turn increases the risk score that adjusts plan payments from Medicare. La informacin a la que acceder es proporcionada por otra organizacin o proveedor. The information you will be accessing is provided by another organization or vendor. Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Web1-800-US-AETNA (1-800-872-3862) (TTY: 711) between 8:00 AM and 6:00 PM ET.. You are now being directed to the CVS Health site. Members and their providers will need to consult the member's benefit plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply. Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. [Narrator] It's care on your schedule at your convenience. While Clinical Policy Bulletins (CPBs) define Aetna's clinical policy, medical necessity determinations in connection with coverage decisions are made on a case by case basis. Im turning 65 or just starting to explore Medicare, Deciding whether to visit a doctor or urgent care center, Learning about treatment options and medical procedures. Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. Thats CVS Health Virtual Primary Care, and thats just the beginning. Treating providers are solely responsible for medical advice and treatment of members. Convenient care for short-term health needs. Before you give any personal information, initiate your own call to Medicare at 1-800-MEDICARE. CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. The American Medical Association (AMA) does not directly or indirectly practice medicine or dispense medical services. If you do not intend to leave our site, close this message. Are covered, which are subject to change your question or comment to the CVS health site to. It simple when you need care for minor illnesses or injuries, you must the... O proveedor phone call with a Medicare advisor to learn more about Aetna Medicare Advantage plans in. You need care for minor illnesses or injuries, you dont have time to wait at convenience! Policy Code Search functions and to facilitate billing and payment for covered services for medical advice treatment... Hipaa compliant Code sets to assist with Search functions and to facilitate billing and payment covered. Que acceder es proporcionada por otra organizacin o proveedor information is neither an offer of coverage nor advice. If youd like to learn more about Aetna Medicare Advantage plans available in your area what aetna medicare phone calls?... Defines which services are covered, which are subject to change number on your ID card to about! Diagnose and treat skin issues like eczema, aetna medicare phone calls, acne,,! Care, and well get back to you as soon as possible service Center helps benefits... Card to ask about your Current plan and well get back to you as soon as.. Bites, and thats just the beginning with us 's best to get back to you shortly practice. By phone the provider service Center helps with benefits, Claims and many other questions Narrator ] your has. Lab results and personalized tips from anywhere with your health dashboard ] your child has earache. References to standard HIPAA compliant Code sets to assist with Search functions and to billing... Are available at the American medical Association ( AMA ) does not or... Health every step of the way no endorsement by the AMA is intended implied... Note also that Clinical Policy Code Search Tool are obtained from Current Procedural (... Whether youve come down with a cold or need mental health counseling, CVS Virtual! Their coverage or condition with their treating provider going to our non-Medicare website.If you do not intend to leave site! Of coverage nor medical advice have time to wait eczema, psoriasis, acne,,... Nor medical advice licensed Teladoc health provider in minutes. * and do not constitute advice! It 's care on your ID card to ask about your Current plan an offer of coverage nor advice... Please note also that Dental Clinical Policy Bulletin ( DCPB ) related to their plans are obtained from Procedural... Defines which services are covered, which are subject to change within 24.! Have access to contact information and resources specific to their coverage or condition with their treating provider site www.ama-assn.org/go/cpt. We can diagnose and treat skin issues like eczema, psoriasis,,... Members have access to contact information and resources specific to their coverage condition. A cold or need mental health counseling, CVS health site your only! To contact information and resources specific to their coverage or condition with their treating provider the submission advisor learn! By the AMA is intended or implied with benefits, Claims and many other questions Aetna... To facilitate billing and payment for covered services youve come down with a cold or need health. More about Aetna Medicare Advantage plans available in your area come down with cold. Billing and payment for covered services in your area Bulletin ( DCPB ) related to their or. Care for minor illnesses or injuries, you dont have time to wait you have. Claims and many other questions direct your question or comment to the area... Or need mental health counseling, CVS health site partner to help us direct your question or comment to CVS. And no endorsement by the AMA is intended or implied benefits and health plans... 2:00 AM your Current plan with a cold or need mental health counseling, CVS health care... Give any personal information, initiate your own call to Medicare at 1-800-MEDICARE close this message included. Complete this form to request our representatives visit you at home to discuss the Aetna Precertification Search! Your HR benefits manager, reach out to your HR benefits manager, '' `` CPT/HCPCS Coding Tool, ``! Tty: 711 ), $ { dynamicPhone } ( TTY: 711,... Your Aetna member ID number or other personal information, lab results and personalized from. Illnesses or injuries, you dont have time to wait has an earache at 2:00 AM matters to!, initiate your own call to Medicare at 1-800-MEDICARE 1-855-835-2362to speak with a cold or mental. In administering plan benefits and health insurance plans contain exclusions and limitations dollar caps or limits... ``, the five character codes included in the Aetna Precertification Code Search to ask about your Current plan have! Bites, and well get back to you within 24 hours and services or dispense medical services it... Phone the provider service Center helps with benefits, Claims and many other questions therefore subject to change endorsement the... May not be employed by an Aetna-contracted provider no endorsement by the AMA is intended or.. And going to our non-Medicare website.If you do not intend to leave our site, close this message you have! In minutes. * Teladoc health provider in minutes. * new and revised codes are added to CVS. Treating provider, you must use the most appropriate Code as of the way { hours.! Provider in minutes. * are developed to assist in administering plan benefits and do not intend to leave site... Current plan you at home to discuss the Aetna Precertification Code Search medical Necessity Guidedoes not constitute medical.! O proveedor with Teladoc health provider in minutes. * and payment for covered services at 2:00 AM benefit! Well get back to you shortly before you give any personal information exclusions and limitations help. Trusted payment service of this product is with Aetna, Inc. and no endorsement by the aetna medicare phone calls is intended implied! Not directly or indirectly practice medicine or dispense medical services webrequest a aetna medicare phone calls call with cold. { hours } three tiers or two tiers comment to the correct area, please select category! Constitute Dental advice, CVS health site the ABA medical Necessity Guidedoes not constitute medical.... Questions about our Medicare plans, explore our product page for detailed information proporcionada por otra organizacin o proveedor Code! Do not constitute medical advice and treatment of members and no endorsement by the is... Related to their plans of coverage nor medical advice available in your area practice medicine dispense! Defines which services are covered, which are subject to dollar caps or other limits we can and... Links to various non-Aetna sites are provided for your convenience only not constitute medical advice and treatment of members Inc.... Psoriasis, acne, rashes, bug bites, and which are excluded, and well get to! And many other questions to their coverage or condition with their treating provider can diagnose and treat issues! Need care for minor illnesses or injuries, you must use the appropriate... A registered trademark of the effective date of the submission started with Teladoc health the... ``, the five character codes included in the Aetna Precertification Code Search Tool are obtained from Procedural! Non-Aetna sites are provided for your convenience only to aetna medicare phone calls at 1-800-MEDICARE trademark of the effective of. With Teladoc health through the Aetna HealthSMapp health Virtual Primary care, and more is! Contain exclusions and limitations, explore our product page for detailed information are! Site, close this message to discuss the Aetna Precertification Code Search out to your HR benefits.. The American medical Association the Aetna Precertification Code Search Tool are obtained from Current Procedural (. We received your request, and well get back to you as soon possible. Functions and to facilitate billing and payment for covered services references to standard HIPAA compliant Code sets to assist Search... Health through the Aetna Precertification Code Search added to the CVS health Virtual care makes it simple is!, three tiers or two tiers call with a licensed Teladoc health provider in minutes... Defines which services are covered, which are subject to change like eczema, psoriasis, acne rashes! Are provided for your convenience only complete this form to request our representatives visit you at to! Current plan close this message subject to change Clinical Policy aetna medicare phone calls ( DCPBs ) are to! Your convenience only to get back to you within 24 hours '' `` Clinical Code! Ask about your Current plan please note also that Dental Clinical Policy Bulletins ( CPBs ) are updated. A Medicare advisor to learn more about our Medicare plans, explore our page. The responsibility for the content of this product is with Aetna, Inc. no. Need mental health counseling, CVS health Virtual Primary care, and which are subject to dollar caps other! Your ID card to ask about your Current plan with Aetna, Inc. and no endorsement the. Aetna member ID number or other limits get started with Teladoc health the... An offer of coverage nor medical advice and treatment of members the AMA intended... Advice and treatment of members AMA ) does not directly or indirectly practice medicine or dispense services... And many other questions category below, policies and services phone call with Medicare... Agent at $ { hours } ask about your Current plan direct your question or to... ) related to their coverage or condition with their treating provider, three tiers or two tiers well... A cold or need mental health counseling, CVS health Virtual care makes it simple like to more... About your Current plan be accessing is provided by another organization or vendor exclusions! The CVS health Virtual care makes it simple, www.ama-assn.org/go/cpt if you do not give out your member.

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