03/26/2024

Aetna Denial for E&M billed with 11721

As of 2024 it seems as if Aetna has stopped reimbursing on office visit codes specifically when 99213 is billed with 11721. They were reimbursing both codes in 2023. Do you have any information on this and have other Podiatrists encounter this issue?

In order to be reimbursed for an established patient (E&M) and an additional procedure-A modifier 25 needs to be appended to the E&M and the condition treated must be unrelated.

There are no changes in 2024 but I’m happy to review the diagnoses that you billed.