13 0 obj As long as your treatment is in-network, Aetna will cover it. WebFee Schedule:15% discount off providers usual charge for covered services less any applicable co- payments, co-insurance, or deductibles. Your benefits plan determines coverage. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. The 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) for a particular member. The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. The Academy has received a number of reports from practices in the area that Aetna intends to reimburse only 75% of what Medicare allows for certain ophthalmological procedures under the Aetnas fee schedule. Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its affiliates (Aetna). endstream CPT only copyright 2015 American Medical Association. If you need to seek emergency care because you feel you are a danger to yourself or others, you do not need to stop and get Aetnas permission beforehand. Called TMS for short, this is an entirely pain-free and non-invasive treatment. This information is neither an offer of coverage nor medical advice. . Treating providers are solely responsible for medical advice and treatment of members. Using TMS Treatment for OCD and Depression, One type of procedure that is becoming increasingly popular among Aetna members is transcranial magnetic stimulation. Keep in mind that Aetna usually does not allow its members to just get whatever medical care they want and then request reimbursement afterward. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. The AMA is a third party beneficiary to this Agreement. }vyk+ u{p4Uwi6m[TUm>us_k.nu]7vfl|y}l]?_cN?Px/R,*}u)i.y}n@_ZX}xjVd7Bnldg\\\uE7mc#[. This means insurance for mental health treatment can cost slightly more than a general checkup visit, but you still get some assistance with the costs. By clicking on I accept, I acknowledge and accept that: Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". They reflect the amounts allowed for services as if Aetna is paying each ASNCPT/HCPCS code on a line-by-line, fee-for-service basis. Note that physician fee schedule information will not display accurate rates for care services provided to Aetna members who participate in an accountable care organization {ACO) arrangement. ,eC(4in#>xq{5]bF@Nt;)=]9SCu^UtzN9?uYwgGq s l! Some payors will see the light and begin to pay on the code. Enter Your ZIP Code to View Sample Savings: Enter Your ZIP Code to View Dentist Listing: Enter Your ZIP Code to View Savings by Procedure: Savings plans are NOT insurance and the savings will vary by provider, plan and This means that alternative treatments that have not been properly studied may not be covered. Treating providers are solely responsible for medical advice and treatment of members. Find plan availability & pricing in your area by Please consult with the respective plan detail page for additional Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. A member with an ACO arrangement will have a member ID card with an ACO logo and/or network name. If you do not intend to leave our site, close this message. The 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) for a particular member. Bank Rates | Sandy Spring Bank endobj 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. CMS develops fee schedules for physicians, ambulance services, clinical laboratory services, and durable medical equipment, prosthetics, orthotics, and supplies. with us to see if Aetna will help pay for your TMS treatments. The American Medical Association (AMA) does not directly or indirectly practice medicine or dispense medical services. CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to the implied warranties of merchantability and fitness for a particular purpose. Aetna will cover your treatment with a therapist who can learn more about your challenges and recommend further treatments. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. [****] Certain information on this page has been omitted and filed The information you will be accessing is provided by another organization or vendor. If you think transcranial magnetic stimulation could help with your mental health challenges, Aetna may cover the cost of your treatments. Since Dental Clinical Policy Bulletins (DCPBs) can be highly technical and are designed to be used by our professional staff in making clinical determinations in connection with coverage decisions, members should review these Bulletins with their providers so they may fully understand our policies. endobj endobj Legally speaking, mental health conditions are treated just like any other condition. Get the care you need now use the program immediately, All patients accepted no health restrictions, Access to specialists with no required referrals, Eliminate unnecessary paperwork and no forms to file. , talk therapy is the starting point. Please be sure to add a 1 before your mobile number, ex: 19876543210. <> Do You Struggle with Treatment-Resistant Depression? Any use of CPT outside of Aetna Clinical Policy Bulletins (CPBs) should refer to the most current Current Procedural Terminology which contains the complete and most current listing of CPT codes and descriptive terms. Aetna It does not mean precertification as defined by Texas law, as a reliable representation of payment of care or services to fully insured HMO and PPO members. For language services, please call the number on your member ID card and request an operator. 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. Keep in mind that some Aetna plans may not have a copay or coinsurance for mental health care. to California residents or on Fully Insured Plans. This Agreement will terminate upon notice if you violate its terms. Treating providers are solely responsible for medical advice and treatment of members. that lets you know how much coverage your plan gives for various treatments. Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. Note that physician fee schedule information will not display accurate rates for care services provided to Aetna members who participate in an accountable care organization {ACO) arrangement.