Advocacy win: Aetna stops denials of modifier 25 claims

In a significant win for DOs and their patients, Aetna has agreed to disable automatic claims denials of E/M services billed on the same day as osteopathic manipulative treatment (OMT) and appended with modifier 25.

How the change happened

The AOA began advocating for this change in 2019, when it became aware of this issue. The AOA worked closely with its physician liaison at Aetna to implement the change, which allows E/M services billed on the same day as OMT codes 98925-98929 to bypass claims edits that previously triggered the denials. The Maine Osteopathic Association also provided advocacy support.

This change could affect DOs practicing in all 50 states and Washington, DC. Physicians participating in Aetna’s health care professional networks who provide OMT on the same day as E/M services should now see significantly fewer claims denials. 


‘We are thrilled’

“We are thrilled to see Aetna eliminate the automatic denial process that caused significant administrative headaches to so many of our physicians who provide OMT to their patients,” says AOA President Ronald Burns, DO, FACOFP. “This change will allow DOs to spend more time on patient care and less time on paperwork.”

The change is effective for services rendered on or after Jan. 1, 2020. For denials prior to this date, the AOA encourages physicians to appeal unfavorable payer decisions. If Aetna rejects a claim for E/M services billed on the same day as OMT and appended with modifier 25 for services provided on or after Jan. 1, please contact AOA Physician Services at [email protected] for assistance.

More information is available on the AOA’s Private Payer Advocacy page.