Members and their providers will need to consult the member's benefit plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply. Yes. This applies to services for: For more details, review your plan documents. Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search. Please see your plan documents. )SI{ 0BO|cEs}Oq""TV}c`u-hSwi8J", hbba`b``30 Ga To receive maximum benefits, members must choose a participating primary care dentist to coordinate their care with in-network providers. For questions about rates or fee schedules, email ProfessionalRates@hca.wa.gov. CPT is developed by the AMA as a listing of descriptive terms and five character identifying codes and modifiers for reporting medical services and procedures performed by physicians. Members should discuss any matters related to their coverage or condition with their treating provider. LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). &,MJtN-F;+U_t+|\b2*M-r!N66;ZWFl\4)*8jw#W`hps>O"9nblas %$puu$|0,}kd4$p$ap,KU{. They may differ by plan. 4792 0 obj <> endobj Aetna Dental members dont need a member ID card to get dental care. Applicable FARS/DFARS apply. endstream endobj 780 0 obj <>/Metadata 30 0 R/Pages 777 0 R/StructTreeRoot 55 0 R/Type/Catalog/ViewerPreferences 798 0 R>> endobj 781 0 obj <>/MediaBox[0 0 612 792]/Parent 777 0 R/Resources<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 782 0 obj <>stream New and revised codes are added to the CPBs as they are updated. *v:G)JeU%IcRr)\%Ts6q^HpCw-yAuYxU'`ho(7;v};}%-`Fuak`Htf,i1+S|@n-2yC%\rk&(NV;*_(bH *-y;tKMJE-V4"%!GUTEj)/3R$F`}C f0]o~lb>9=Grn5+;X@:D?CwX}/fb'e[=A3[ ~m;j\ZOE%H8RsZg ~mH.l%:~EYwO-$Hcm6dqaW[dc( z The AMA disclaims responsibility for any consequences or liability attributable or related to any use, nonuse or interpretation of information contained in Aetna Precertification Code Search Tool. CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to the implied warranties of merchantability and fitness for a particular purpose. Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. 0000021213 00000 n interpreter services at no cost. 0000001836 00000 n Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. License to sue CPT for any use not authorized herein must be obtained through the American Medical Association, CPT Intellectual Property Services, 515 N. State Street, Chicago, Illinois 60610. Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. However, in order to receive maximum benefits, members must select and have care coordinated by a participating primary care dentist. 206 0 obj <>stream For general Apple Health and behavioral health guidance, visit our Information about novel coronavirus (COVID-19) webpage. The $150 co-payment is for a plain metal crown. Just enter your mobile number and well text you a link to download the Aetna Health app from the App Store or on Google Play. Preferred Dentist Program - MetLife Network dentists are paid contracted fees. WebWorldwide dental coverage and plans with no deductible New Hires have 60 days to choose benefits. To find out, just call Member Services. Illinois DMO is not an HMO. You can reach them at the number on your member ID card. 0000072473 00000 n Federal Dental Insurance | MetLife FEDVIP 2023 50% of costs until plan has paid $1,750, then any All Rights Reserved. What you pay will be based on a percentage of those charges (coinsurance). Choose a primary care dentist who participates in our network. 0000001199 00000 n Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. If we have primary responsibility, we will pay as the primary payor. How does the plan save me money? It will show you whether a drug is covered or not covered, but the tier information may not be the same as it is for your specific plan. Choose a category below to see questions and answers about Dental Maintenance Organization (DMO) coverage. Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. If so, the primary care doctor will arrange it. Links to various non-Aetna sites are provided for your convenience only. You or your dentist may also call Member Services. Predeterminations may not be available in all states. Since Dental Clinical Policy Bulletins (DCPBs) can be highly technical and are designed to be used by our professional staff in making clinical determinations in connection with coverage decisions, members should review these Bulletins with their providers so they may fully understand our policies. 0000036990 00000 n No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. WebWe would like to show you a description here but the site wont allow us. WebJuly 1, 2022 to present Mobile anesthesia for dental services billing guide; Fee schedules. For questions about billing guides, contact Medical Assistance Customer Service Center (MACSC) online or at 1-800-562-3022. For step-by-step instructions on completing a PA, visit our Prior authorization (PA) page. When billing, you must use the most appropriate code as of the effective date of the submission. Aetna defines a service as "never effective" when it is not recognized according to professional standards of safety and effectiveness in the United States for diagnosis, care or treatment. 0000039476 00000 n BG[uA;{JFj_.zjqu)Q and Section 504 of the Rehabilitation Act of 1973. If you choose a new PCD on or before the fifteenth of the month, the change will go into effect on the first day of the following month. Enter the street name or intersection instead of address numbers (24th and Broadway instead of 2432 Broadway). For language services, please call the number on your member ID card and request an operator. DNO (Dental Network Only) in Virginia is not an HMO. hbbd```b`` 0000050717 00000 n 0000016734 00000 n Members should discuss any Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider. All agency-contracted managed care organizations (MCOs) and the fee-for-service (FFS) program use the Apple Health PDL. If so, we will confirm which plan has primary responsibility for claim payment. What types of services does the plan cover? 797 0 obj <>/Filter/FlateDecode/ID[<37A34B695481DA4B83FCA71461750ABE><99A26598FF436C418BD6EB0A4885ABA5>]/Index[779 47]/Info 778 0 R/Length 98/Prev 235657/Root 780 0 R/Size 826/Type/XRef/W[1 3 1]>>stream WebAll Other Dental Services You Pay $0 In-Network $50 Out-of-Network $50 The maximum amount Guardian will reimburse you for dental services received Limitations and Exclusions (see your policy for further details) We will not pay Notice: Past billing guides may have broken links. 0000071744 00000 n Ooops!!! - MetLife WebAmount of every $100 in premiums used to pay for claims and administration for the year ending Dec. 31, 2017 You can still visit any licensed dentist, but your out-of-pocket costs may be higher if you choose a non-PPO dentist. WebMetLifes Table of Maximum Allowable Charges or Fee Schedule applies to dental procedures performed on eligible members participating in MetLifes Preferred Dentist January 1, 2023 to present Dental program fee schedule (updated January 26, 2023) See Access to Baby and Child Dentistry (ABCD). When you go to or call the dentist, tell the office staff that you have Aetna Dental DMO. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Metropolitan Life Insurance Company, New York, NY 10166 Treating providers are solely responsible for medical advice and treatment of members. August 1, 2022 to present Neurodevelopmental centers billing guide, July 1, 2022 to July 31, 2022 Neurodevelopmental centers billing guide, July 1, 2021 to June 30, 2022 Neurodevelopmental centers billing guide, View all neurodevelopmental centers billing guides, July 1, 2022 to present Neurodevelopmental centers fee schedule, July 1, 2021 to June 30, 2022 Neurodevelopmental centers fee schedule, January 1, 2021 to June 30, 2021 Neurodevelopmental centers fee schedule, View all neurodevelopmental centers fee schedules, January 1, 2019 to March 31, 2019 Nondurable medical supplies and equipment billing guides, July 1, 2018 to December 31, 2018 Nondurable medical supplies and equipment billing guides, View all nondurable medical supplies and equipment billing guides, January 1, 2019 to March 31, 2019 Nondurable medical supplies and equipment fee schedule, April 1, 2023 to present Nursing facilities billing guide, January 1, 2023 to March 31, 2023 Nursing facilities billing guide, October 1, 2022 to December 31, 2022 Nursing facilities billing guide, View all nursing facilities billing guides, April 1, 2023 to present Orthodontic services billing guide, January 1, 2023 to March 31, 2023Orthodontic services billing guide, October 1, 2022 to December 31, 2022 Orthodontic services billing guide, View all orthodontic services billing guides, August 1, 2022 to present Outpatient hospital services billing guide, July 1, 2022 to July 31, 2022 Outpatient hospital services billing guide, April 1, 2022 to June 30, 2022 Outpatient hospital services billing guide, April 1, 2023 to present -- OPPS fee schedule, January 1, 2023 to March 31, 2023 OPPS fee schedule, October 1, 2022 to December 31, 2022 OPPS fee schedule, July 1, 2022 to September 30, 2022 OPPS fee schedule, April 1, 2022 to June 30, 2022 OPPS fee schedule, January 1, 2022 to March 31, 2022 OPPS fee schedule, October 1, 2021 to December 31, 2021 OPPS fee schedule, August 1, 2022 to present Outpatient rehabilitation billing guide, July 1, 2022 to July 31, 2022 Outpatient rehabilitation billing guide, January 1, 2022 to June 30, 2022 Outpatient rehabilitation billing guide, View all Outpatient Rehabilitation Program billing guides, July 1, 2022 to present Outpatient rehabilitation fee schedule, July 1, 2021 to June 30, 2022 Outpatient rehabilitation fee schedule, January 1, 2021 to June 30, 2021 Outpatient rehabilitation fee schedule, View all Outpatient Rehabilitation Program fee schedules, July 1, 2022 to present Pharmacy Special Services fee schedule, July 1, 2021 to June 30, 2022 Pharmacy Special Services fee schedule, July 1, 2020 to June 30, 2021 Pharmacy Special Services fee schedule, View all pharmacy special services fee schedules, May 1, 2023 to present - Physician-related services/health care billing guide, April 1, 2023 to April 31, 2023 Physician-related services/health care billing guide, January 1, 2023 to March 31, 2023 Physician-related services/health care billing guide, View all physician-related/professional services billing guides, April 1, 2023 to present Physician-related services fee schedule, January 1, 2023 to March 31, 2023 Physician-related services fee schedule, October 1, 2022 to December 31, 2022 Physician-related services fee schedule, View all physician-related/professional services fee schedules, January 1, 2023 to present Enhanced pediatric fee schedule, July 1, 2022 to December 31, 2022 Enhanced pediatric fee schedule, October 1, 2021 to June 30, 2022 Enhanced pediatric fee schedule, View all enhanced pediatric fee schedules, January 1, 2023 to present Enhanced adult primary care fee schedule, July 1, 2022 to December 31, 2022 Enhanced adult primary care fee schedule, October 1, 2021 to June 30, 2022 Enhanced adult primary care fee schedule, January 1, 2023 to present Opioid use disorder fee schedule, July 1, 2022 to December 31, 2022 Opioid use disorder fee schedule, July 1, 2021 to June 30, 2022 Opioid use disorder fee schedule, View all medication for opioid use disorder fee schedules, July 1, 2022 to present Conversion factors, July 1, 2021 to June 30, 2022 Conversion factors, July 1, 2020 to June 30, 2021 Conversion factors, Centers of Excellence: organ transplant facilities directory, April 1, 2023 to present Planned home births and births in centers billing guide, January 1, 2023 to March 31, 2023 Planned home births and births in centers billing guide, October 1, 2022 to December 31, 2022 Planned home births and births in centers billing guide, View all planned home births billing guides, January 1, 2023 to present Planned home births and births in centers fee schedule, July 1, 2022 to December 31, 2022 Planned home births and births in centers fee schedule, July 1, 2021 to June 30, 2022 Planned home births and births in centers fee schedule, View all planned home births fee schedules, July 1, 2022 to present Prenatal diagnosis genetic counseling fee schedule, July 2021 to June 30, 2022 Prenatal diagnosis genetic counseling fee schedule, July 1, 2020 to June 30, 2021 Prenatal diagnosis genetic counseling fee schedule, View all prenatal diagnosis genetic counseling fee schedules, January 1, 2023 to present Prescription drug program billing guide, April 1, 2022 to December 31, 2022 Prescription drug program billing guide, October 1, 2021 to March 31, 2022 Prescription drug program billing guide, January 1, 2023 to present Expedited authorization codes and criteria table, June 1, 2022 to December 31, 2022 Expedited authorization codes and criteria table, December 1, 2021 to May 31, 2022 Expedited authorization codes and criteria table, February 21, 2023 to present Private duty nursing for children billing guide, July 1, 2022 to February 20, 2023 Private duty nursing for children billing guide, October 1, 2020 to June 30, 2022 Private duty nursing for children billing guide, View all private duty nursing for children billing guides, January 1, 2023 to present Private duty nursing fee schedule, January 1, 2020 to December 31, 2022 Private duty nursing fee schedule, July 1, 2016 to December 31, 2019 Private duty nursing fee schedule, April 1, 2023 to present Professional administered drug fee schedule, January 1, 2023 to March 31, 2023 Professional administered drug fee schedule, October 1, 2022 to December 31, 2022 Professional administered drug fee schedule, View all professional administered drugs fee schedules, July 1, 2022 to present Prosthetic and orthotic devices billing guide, April 1, 2022 to June 30, 2022 Prosthetic and orthotic devices billing guide, October 1, 2021 to March 31, 2022 Prosthetic and orthotic devices billing guide, View all prosthetic and orthotics billing guides, July 1, 2022 to present Prosthetic and orthotics fee schedule, October 1, 2021 to June 30, 2022 Prosthetic and orthotics fee schedule, July 1, 2021 to September 30, 2021 Prosthetic and orthotics fee schedule, View all prosthetic and orthotics fee schedules, August 1, 2022 to present Respiratory care billing guide, July 1, 2022 to July 31, 2022 Respiratory care billing guide, October 1, 2021 to June 30, 2022 Respiratory care billing guide, July 1, 2022 to present Respiratory care fee schedule, October 1, 2021 to June 30, 2022 Respiratory care fee schedule, July 1, 2021 to September 30, 2021 Respiratory care fee schedule, April 1, 2023 to present Rural heath clinics billing guide, January 1, 2023 to March 31, 2023 Rural health clinics billing guide, October 1, 2022 to December 31, 2022 Rural health clinics billing guide, April 1, 2023 to present RHC encounter rates, January 1, 2023 to March 31, 2023 RHC encounter rates, October 1, 2022 to December 31, 2022 RHC encounter rates, April 1, 2023 to present RHC enhancement rates, January 1, 2023 to March 31, 2023 RHC enhancement rates, October 1, 2022 to December 31, 2022 RHC enhancement rates, October1, 2022 to present SBHS billing guide, July 1, 2022 to September 30, 2022 SBHS billing guide, October 1, 2021 to June 30, 2022 SBHS billing guide, July 1, 2022 to present SBHS fee schedule, October 1, 2021 to June 30, 2022 SBHS fee schedule, July 1, 2021 to September 30, 2021 SBHS fee schedule, January 1, 2023 to present Sleep centers billing guide, July 1, 2022 to December 31, 2022 Sleep centers billing guide, October 1, 2020 to June 30, 2022 Sleep centers billing guide, April 1, 2023 to present Sleep centers fee schedule, January 1, 2023 to March 31, 2023 Sleep centers fee schedule, July 1, 2022 to December 31, 2022 Sleep centers fee schedule, January 1, 2023 to Present Sterilization billing guide, October 1, 2022 to December 31, 2022 Sterilization billing guide, July 1, 2022 to September 30, 2022 Sterilization supplemental billing guide, Physician-related/Professional Services Billing Guide, Sterilization Consent Form (HHS-687) (English), Sterilization Consent Form (HHS-687) English large print, Sterilization Consent Form (HHS-687-1) (Spanish), Sterilization Consent Form (HHS-687-1) Spanish large print, 1, 2023to present Substance use disorder billing guide, January 1, 2023to March 31, 2023 Substance use disorder billing guide, October 1, 2022 to December 31, 2022 Substance use disorder billing guide, View all SUD (FFS outside BHO process) billing guides, July 1, 2022 to present Substance use disorder fee schedule, October 1, 2021 to June 30, 2022 Substance use disorder fee schedule, January 1, 2021 to September 30, 2021 Substance use disorder fee schedule, View all substance use disorder fee schedules, January 1, 2023 to present Substance-Using Pregnant People (SUPP) Program billing guide, February 26, 2023 to present Telemedicine billing guide, January 1. endstream endobj 4804 0 obj <>stream CPT is a registered trademark of the American Medical Association. startxref 4828 0 obj <>stream \-.m\EqYt0.\fj JR Hn0R`~(dQQl\0H5oKtFA?v>4.zL >.K;J+p0eLK!YWU-`}\~nxqC79*G: >$LAFMEECJ.&rwBx77C(gOI CHAwl"4Q !b p^y2gp#M