Our member support team is available 24/7 to answer any questions that arise. Metabolic, hepatic, or renal compromise including: Poorly controlled diabetes (hemoglobin A1C > 7), End-stage renal disease with hyperkalemia (serum potassium level of >5.0, (mmol/L) or undergoing regularly scheduled peritoneal dialysis or hemodialysis, Alcohol dependence (at risk for withdrawal syndrome), History of myocardial infarction (MI) within 90 days prior to planned surgical procedure, Cardiac arrhythmia (symptomatic arrhythmia despite medication), Hypertension resistant to concurrent use of three (3) or more prescription medications, Uncompensated chronic heart failure (CHF) (NYHA class III or IV). The purpose of this policy is to define payment criteria for emergency room claims when billed with Level 4 and Level 5 E/M codes to be used in making payment decisions and administering benefits. We are new to Aetna and we have specialists that care for a chronic condition. Clinical policy bulletins. An emergency room copay does not apply when you are admitted for an overnight hospital stay. New and revised codes are added to the CPBs as they are updated. AetnaBetter Health of Illinois is not responsible or liable for content, accuracy or privacy practices of linked sites or for products or services described on these sites. If you have a Medicare Advantage plan, however, your plan includes an out-of-pocket spending limit . The member's benefit plan determines coverage. 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 responsibility for the content of Aetna Clinical Policy Bulletins (CPBs) is with Aetna and no endorsement by the AMA is intended or should be implied. Others have four tiers, three tiers or two tiers. In case of a conflict between your plan documents and this information, the plan documents will govern. Per our policy, screening of asymptomatic pregnant women for bacterial vaginosis (BV) to reduce the incidence of pre-term birth or other complications of pregnancy is not medically necessary as there is no evidence that treatment of BV in asymptomatic pregnant women reduces these complications. Procedure code and Descripiton 99281 (CPT G0380) Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: A problem focused history; A problem focused examination; and Straightforward medical decision making. This link will take you to the AetnaBetter Healthof Illinoisvendor website. 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.

Swiffer Commercial Actress Tessa, Articles A