Aetna rolls back the telehealth coverage it expanded due to COVID-19

Editor's note (Dec. 20, 2023): This post has been updated to note that Aetna has since said these changes will apply only to self-insured commercial plans, which make up about 70% of Aetna's commercial business. 

Aetna, one of the nation’s largest health insurers, has released a list of telemedicine services it will no longer cover for its self-funded commercial plans for dates of service on or after Dec. 1, 2023. Like most payers, Aetna expanded its telehealth coverage in response to the COVID-19 pandemic, and has continued that coverage since the formal pandemic public health emergency expired on May 11. But the company is now rolling it back.

Practices can view the full list of services that will no longer be covered by visiting the Availity Provider Portal (Aetna Payer Space > Resources > Claim Resources > “Telemedicine liberalized codes no longer covered effective 12.1.23”). The changes apply to Aetna’s self-insured commercial line of business nationwide (which makes up about 70% of the company's commercial business), but in Washington state the effective date may be different due to regulatory review.

The list is separated into three sections. Below are the CPT/HCPCS codes most relevant to primary care in each section that will no longer be covered.

1. Non-audiovisual, non-telephonic online communication, and telephone coverage:

• E-visits (99421-99423),
• Telephone evaluation and management (E/M) (99441-99443),
• Initial nursing facility care, per day, for the E/M of a patient (99304-99306),
• Nursing facility discharge management (99315-99316),
• Home or residence visits (99341-99350),
• Virtual check-ins (HCPCS G2010, G2012, G2250, G2251, and G2252).

2. Audio-visual coverage (Modifiers 95, GT, FR):

• Home or residence visit for the E/M of an established patient (99347-99349).

3. Audio-only coverage (Modifiers 93, FQ):

• Advanced care planning (99497 and 99498),
• Prolonged office or other outpatient E/M service(s) beyond the maximum required time (HCPCS G2212),
• Behavioral health counseling (HCPCS G0443-G0447),
• Comprehensive assessment of and care planning for patients requiring chronic care management services (HCPCS G0506).

Aetna also released an updated version of its Telemedicine and Direct Patient Contact Payment Policy that also went into effect Dec. 1, 2023, and is accessible on the Availity website. The policy notes that Aetna will align with the Centers for Medicare & Medicaid Services (CMS) regulations for its Medicare Advantage plans. Medicare’s list of telehealth services is available in the List of Telehealth Services for Calendar Year 2023. Coverage policies for Aetna’s Medicaid plans will vary by state.

If you have questions regarding these changes, please visit Aetna’s Contact page.

— Brennan Cantrell, AAFP Commercial Health Insurance Strategist

Posted on Nov. 14, 2023