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- CAP Urges Aetna to Reverse Reimbursement Limits, Clinical Pathology Services
The CAP opposed a new Aetna reimbursement policy that would restrict payment for pathologists in Texas and urged the insurer to reconsider these changes. In a December 20 letter to Aetna of North Texas and Oklahoma, the CAP urged the insurer to reverse recent reimbursement policy changes for modifier-26 and continue payment for the professional component of clinical pathology. The CAP has requested a meeting to discuss this issue further.
As pathologists are the physician director of a clinical laboratory, the CAP outlined that if Aetna were to discontinue reimbursement for the professional component of clinical pathology services, the policy would prove detrimental to patients and to the integrated delivery of care to which laboratory diagnostic services are central, the letter said. The CAP further argued that the CMS already recognizes the significance of the services provided by the pathologist-director by including “the Part A payment Medicare makes to hospitals for each patient.” Therefore, cutting these payments would be inconsistent with the current CMS policy.
The CAP will provide updates in future newsletter articles