Aetna
Welcome to the Aetna page. Here you can access useful materials about the program.
Aetna has selected National Imaging Associates, Inc. (NIA) to provide utilization management for physical medicine. Beginning September 1, 2018, for Delaware, New York, Pennsylvania and West Virginia, providers must request prior authorization for physical therapy, occupational therapy and chiropractic services through NIA at RadMD.com.
Refer to the state-specific CPT Matrix document below to view specific codes managed by NIA.
Physical Medicine
Beginning September 1, 2018, any provider that is performing physical therapy, occupational therapy or chiropractic services must contact NIA for prior authorization. (Delaware, New York, Pennsylvania, West Virginia)
Prior authorization will be required for Aetna New Jersey and western New York effective January 1, 2019.
Effective August 1, 2019, CPT Codes 98925 - 98929 for Osteopathic Physicians do not require prior authorization for Aetna Members.
Delaware
- Delaware PT, OT and Chiropractic Letter
- Delaware Physical Medicine Webinar Invitation
- Physical Medicine CPT Matrix 2019
- Physical Medicine QRG
- Physical Medicine FAQ
- Physical Medicine Education PowerPoint
- Physical Medicine Tip Sheet/Checklist
- Recording of Aetna Webinar Training
New Jersey
- NJ Annoucement Letter
- NJ Physical Medicine Webinar Invitation
- NJ Physical Medicine CPT Matrix 2019
- NJ Physical Medicine QRG
- Ordering Provider Access
- RadMD Quick Start Guide
- RadMD Upload Feature
- NJ Physical Medicine Provider Education PowerPoint
- NJ Physical Medicine Medicine FAQ
- Physical Medicine Tip Sheet/Checklist
New York
- NY Chiropractic Letter
- NY Physical Therapy and Occupational Therapy Letter
- NY Physical Medicine Webinar Invitation
- NY Physical Medicine CPT Matrix 2019
- Physical Medicine QRG
- Physical Medicine FAQ
- NY Physical Medicine Education PowerPoint
- Physical Medicine Tip Sheet/Checklist
- Recording of Aetna Webinar Training
Western New York
- Western NY Combined Expansion Letter
- Western NY Physical Medicine Webinar Invitation
- Western New York Physical Medicine Education PowerPoint
- Physical Medicine Tip Sheet/Checklist
- RadMD Upload Feature
Pennsylvania
- Aetna Coventry Physical Medicine Education PowerPoint
- Western PA PT,OT,Chiropractic Letter
- Eastern PA PT, OT, Chiropractic Letter
- Aetna PA Physical Medicine Webinar Invitation
- Physical Medicine CPT Matrix 2019
- Physical Medicine QRG
- Physical Medicine FAQ
- Physical Medicine Tip Sheet/Checklist
- Recording of Aetna Webinar Training
West Virginia
- Aetna Coventry Physical Medicine Education PowerPoint
- WV PT,OT Chiropractic Letter
- Aetna WV Physical Medicine Webinar Invitation
- Physical Medicine CPT Matrix
- Physical Medicine QRG
- Physical Medicine FAQ
- Physical Medicine Tip Sheet/Checklist
- Recording of Aetna Webinar Training
Documents
RadMD User References
Physical Medicine Guidelines
Refer to the state-specific CPT Matrix document above to view specific codes managed by NIA.
Therapy
Chiropractic
General
- Active Procedures in Physical Medicine 2018
- Experimental Unproven Investigational Services 2018
- Measurable Progressive Improvement 2018
- Passive Treatment 2018
- Plan of Care 2018
- Record Keeping and Documentation Standards 2018
Apollo Guidelines
Other Documents
- NIA Chiropractic Services-Novitas (L35424)
- NIA Outpatient Occupational Therapy-Palmetto GBA (L34427)
- NIA Outpatient Physical Therapy-Palmetto GBA (L33428)
- Therapy and Rehabilitation Services (PT OT)-Novitas (L35036)