• 1.  Aetna in NEW JERSEY

    Posted 10-18-2022 19:00

    Is anyone else having trouble getting paid for CPT codes 76813,76811 with payer AETNA ? IF so is there any tips on how I  can get these ultrasounds paid, All of our patients are high risk and I use ICD-10 codes such as O09.529, O35.8XX1, O28.3, E66.01, O35.1XX1 O09.299.

    Thank you

    David PRINCIPE

  • 2.  RE: Aetna in NEW JERSEY

    Posted 10-20-2022 13:15
    Hi David
    That is surprising.  I've linked their CPB here:  Ultrasound for Pregnancy
    The codes you suggested/ listed are considered appropriate for 76813 and 76811
    Apart from contacting your rep/payer, I am not sure why for your particular practice/ultrasound/billing is not being reimbursed. 

    Vanita Jain, MD
    Chair, SMFM Coding Committee