Aetna Fee Schedule changes to take effect April 1

Posted 4-3-12

CMA recently learned of changes to the Aetna Market Fee Schedule (AMFS) that will take effect April 1, 2011 for commercial lines of business in Northern California.

In a December letter, Aetna informed physicians that it would be modifying physician reimbursement rates based on the service location zip code of the rendering physician.

Physicians within specified geographical areas will be broken into payment regions based on their county and corresponding zip codes as assigned under the Medicare Geographical Practice Cost Index (GPCI).

CMA has created a financial impact worksheet to help physicians assess the impact the fee schedule changes will have on their practices based on their most commonly billed CPT codes. This worksheet is available to members only.

To help physicians understand their rights when a health plan has sent notice of a material change to a contract, CMA has published “Contract Amendments: an Action Guide for Physicians.”
The guide includes a discussion of options available to physicians when presented with a material change to a contract.
If you have questions about the new contract terms, contact the Aetna Provider Service Center at (888) 632-3862.

If you would like a copy of any of the downloads referred to in this article, contact sandie@sccma.org.