Aetna’s Important Message Regarding Aetna’s Payment Policy for Modifier -57

Important Message Regarding Aetna’s Payment Policy for Modifier -57 for Evaluation and Management (E&M) Visits at Which Decision for Surgery Is Made

Aetna has reached an agreement with state medical societies, including the Medical Society of the State of New York (MSSNY), to pay resubmitted claims for E&M visits billed with a Modifier -57 (indicating that the decision for surgery was made during the visit), for dates of service from January 1, 2005 through February 11, 2006. After seeking input from medical societies, including MSSNY and the independent Physician Advisory Board, Aetna decided to change its policy and began paying these claims effective February 12, 2006.

When May Claims be Resubmitted?
The resubmission period will begin on January 1, 2007 and will extend through April 30, 2007. Please use the following spreadsheet to resubmit applicable claims.

Online information is available
We will post key information, including detailed instructions and forms that are required to ensure timely and accurate processing of the resubmitted claims as shown above and information and forms will also be posted on