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Provider Notification - E&M Ophthalmology - Error Fix for Denied Claims

Aetna Better Health of Virginia·VA · Ophthalmology·Reimbursement
Effective date
Jul 1, 2025
We identified it
Aug 13, 2026
Days to comply

Summary

Aetna Better Health of Virginia is correcting an error that caused claims to be wrongly denied when E&M services were billed together with specific ophthalmological procedure codes. The payer has removed these codes from the denial trigger list retroactively to July 1, 2025, and will automatically reprocess all affected claims after system updates are complete by February 1, 2026.

Action Required

Action needed
By February 1, 2026: Billing team should monitor the system update completion and verify that Aetna Better Health of Virginia's billing system no longer denies E&M claims (99201-99215) when billed with ophthalmology procedure codes 92012-92014, 92015, 92018-92020, 92025, 92060, 92065-92066, 92071-92072, 92081-92083, 92100, 92132-92134, 92136, 92145, 92201-92202, 92227-92230, 92235, 92240, 92242, 92250, 92260, 92265, 92270, 92273-92274, 92283-92287. No proactive action is required; Aetna will automatically reprocess denied claims from July 1, 2025 forward. Allow 30-60 days after February 1, 2026 for claim reprocessing. Track and monitor reprocessed claims to ensure they are now being paid. Update internal billing guidelines and claim denial tracking to remove the E&M + ophthalmology procedure code conflict as a known issue.

Affected Billing Codes

92012
92013
92014
92015
92018
92019
92020
92025
92060
92065
92066
92071
92072
92081
92082
92083
92100
92132
92133
92134
92136
92145
92201
92202
92227
92228
92229
92230
92235
92240
92242
92250
92260
92265
92270
92273
92274
92283
92284
92285
92286
92287