All Health Plans

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.

Date Extension Announcement for Physical Medicine Providers (New)

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

New Jersey

New York

Western New York

Pennsylvania

West Virginia

Documents

Physical Medicine Tip Sheet/Checklist

RadMD User References

Physical Medicine Guidelines

Refer to the state-specific CPT Matrix document above to view specific codes managed by NIA.

Physical Medicine Guidelines

MCG Guidelines®

Magellan adopted the use of MCG Guidelines® for its Physical Medicine product. More information available here: /media/871888/instructions-for-accessing-mcg-guidelines-ambcare.pdf