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.
“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.