- April 29, 2020
- Posted by: CB&C
- Category: Publications
If you have noticed recently that UHC and Aetna seem to be applying a ‘Multiple Therapy Reduction’ to their claims payment, you are not alone.
Both UHC and Aetna seem to be adopting Medicare’s policy on using a ‘Multiple Therapy Reduction’ formula when a provider (chiropractor or physical therapist) bills more than 1 ‘97’ code on any one date of service. Medicare’s policy became effective January 1, 2011 whereas Aetna adopted its use of this policy effective November 14, 2011. This “Multiple Therapy Reduction” isn’t applied to just one product, it applies to all Aetna products. Unfortunately, UHC is also applying this methodology of payment.
You may find when reviewing your EOBs it’s difficult to decipher exactly how the claims are paying as well as trying to decide if the payments are correct. The Multiple Therapy Reduction formula is as follows: the modality with the highest RVU is allowed at 100% of the allowable rate. For subsequent units and procedures, performed on the same patient on the same day, the Reduction is at 80% of the allowable rate—less the patient’s benefit.
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