Aetna’s Payment Policy of EKG 12-Lead Service


Important Message Regarding Aetna’s Payment Policy of EKG 12-Lead Service (CPT 93010) When Billed With an Emergency Room Evaluation & Management (E&M) Code (CPT 99281-99285)

Effective August 12, 2006 Aetna will consider claims for electrocardiograms (EKG) 12-lead service (CPT code 93010) when billed with an Emergency Room Evaluation & Management (E&M) service (CPT codes 99281-99285) with or without appending a Modifier 25 to the E&M Code.

Why this policy changed
Aetna’s decision to change its payment policy stemmed from discussions with a group of North Carolina Emergency Department physicians and goes further than what is required by the physician settlement agreement. Organized medicine commends Aetna for going beyond the settlement agreement to change its payment policies in a manner favorable to physicians.

Previously denied claims can be resubmitted
Physicians (including participating, nonparticipating and retired) may resubmit previously denied claims for the prior six months (February 10, 2006 through August 11, 2006). Physicians have up to and including November 11, 2006 to resubmit these claims. Beginning with claims processed on or after August 12, 2006, all claims submitted will be adjudicated according to the new payment policy. Timely filing and appeal deadlines will be waived. Late interest and penalty payments will not apply to these claims. Please note: all other policies will still apply and may impact the ultimate payment of the codes, including the payment of only one professional interpretation per EKG performed.

Online information is available
Aetna has posted key information, detailed instructions and forms that are required to ensure timely and accurate processing of the resubmitted claims on Select “for Health Care Professionals,” then under the Features section, select “Aetna to consider claims for EKG 12–Lead Service when billed with an E&M Code.” A link will also be posted under the “Claims” section of the secure provider website, available through To log in, select “for Health Care Professionals,” “Physician Self-Service” and “Log In.”

Contact Aetna with questions
For further information about the resubmission of previously denied claims, or if you are unable to submit claims via, please call Aetna’s Provider Service Center at 1-800-624-0756 for HMO-based benefits plans or 1-888-MDAetna (1-888-632-3862) for indemnity and PPO-based benefits plans.

EKG 12-Lead Service (CPT 93010) When Billed With an Emergency Room Evaluation & Management (E&M) Code (CPT 99281-99285)

EKG 12-Lead Services Spreadsheet
This spreadsheet is to be used to resubmit previously denied claims pertaining to:
— EKG 12-Lead Services (CPT Codes 93010) billed with an Evaluation and Management Code (CPT Codes 99281 – 99285) provided to Aetna members between 2/10/96 and 8/11/06

Please download this spreadsheet and complete all highlighted fields. Save the completed spreadsheet to your hard drive.