Aetna joins UnitedHealthcare among the commercial insurers that have expanded coverage from more limited e-visit provisions.
UPDATE (April 3): Aetna has advised that telehealth services delivered by physical therapists may be billed on a UB04 using the modifier GT or 95. Please contact advocacy@apta.org with any issues or questions associated with this billing.
Private insurer Aetna announced that it will now cover a range of services delivered by PTs through telehealth—a significant expansion of its earlier COVID-19-related policy that limited coverage to e-visits. The change comes after APTA engaged in collaborative work with the company to rethink its temporary benefits policy.
The insurer, officially known as CVS Health/Aetna, will cover the telehealth-based delivery of the services and procedures by PTs for CPT codes 97161, 97162, 97163, 97164, 97110, 97112, 97116, 97535, 97755, 97760, and 97761. The telehealth care must be provided as a two-way synchronous (real-time) audiovisual service. Providers are required to append the GT modifier to the codes. Aetna's expansion follows a similar move by UnitedHealthcare.
Aetna will also continue its policy that reimburses PTs for the provision of e-visits, virtual check-ins, and telephone services. The use of the GT or 95 modifier is not required for e-visit CPT codes (98970, 98971, 98972), the store-and-forward code (G2010), virtual check-in codes (G2012), and telephone assessment CPT codes (98966, 98967, 98968). Visit Aetna's provider website and follow instructions for accessing detailed policy information on the provider portal.