Burden Removed

Prior authorization requirement for OMT ends for Aetna patients in five states

Osteopathic advocates convince Aetna to reverse course on OMT codes.

In a significant win for 23,000 DOs and their patients, Aetna has agreed to drop its prior authorization requirement for osteopathic manipulative treatment (OMT).

The reversal became effective Aug. 1 and exempts CPT codes 98925–98929 from Aetna’s prior authorization requirements. The change is in effect in five states.

AOA leadership and staff partnered with affiliates in New Jersey, New York, Pennsylvania, West Virginia and Delaware to advocate for reversal of the policy, which affected Aetna’s fully insured commercial and Medicare plans.

Barrier eliminated

“This change eliminates a barrier to safe, effective relief for patients seeking treatment for musculoskeletal pain, reflecting the understanding that pharmaceuticals shouldn’t be the only option physicians can immediately provide. AOA appreciates Aetna’s recognition of the value of osteopathic care and its decision to reduce administrative burden for DOs who perform OMT,” says AOA President Ronald Burns, DO, FACOFP.

Aetna’s medical policy recognizes OMT as a separate, distinct service performed only by physicians with a full and unrestricted license for medicine and surgery. However, the prior authorization policy enacted in September 2018 swept OMT into physical medicine for prior authorization purposes. Physical medicine includes physical therapy, occupational therapy and chiropractic care.

Patients over paperwork

Reducing administrative burden for physicians is an AOA priority. The AOA’s physician services team partners with affiliates to collaborate on advocacy efforts aimed at reducing the amount of time DOs spend on paperwork instead of patients.

5 comments

  1. This is fantastic! Glad to see the AOA helping insurers realize the errors of their ways in how they process claims regarding OMT. AOA, now please set your sights on helping those of us in CA fighting Anthem’s new policy to deny any claim with a 25 mod. with same/similiar diagnosis within 90 days. Anthem is causing my practice tremendous financial and logistical strain with their new policy.

    1. AOA and its affiliates are actively engaged on this issue, working with physicians like you to document the impact of this policy. Currently, the team is collecting claim denial information and will be analyzing overall impact for use in its advocacy work with Anthem.

      1. Thank you. This is also a big problem with Cigna. Happy to provide denied claims for both Anthem and Cigna. Appreciate your work to help eliminate the frustration and lack of payment for us!

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