Aetna Wrongful Denials and Appeals

The ACA has been working with Aetna, who agreed to pay for 97140 when billed with CMT as long as the service was provided to a separate region and documentation for medical necessity accompanied claim. But wrongful denials have been continuing. In order to help DCs who contract with Aetna, the ACA has made the following resources available:

• How to File a Claim or Submit an Appeal: This document describes in detail the steps necessary to properly submit a claim or file an appeal containing 97140 and CMT to Aetna.
• Filing the Initial Claim: Use this cover letter when submitting an initial claim with 97140 and CMT to Aetna.
• Appealing a Denial: Use this cover letter to accompany an appeal of a denied 97140 and CMT Aetna claim.