Advocacy win: Aetna corrects inappropriate modifier 58 claim denials

As a direct result of AADA advocacy, Aetna fixed their processing errors that inappropriately denied modifier 58 claims and has already reprocessed these claims for payment. Modifier 58 is used when performing a staged or related procedure within the global period of another procedure.

Members contacted AADA because Aetna was wrongfully denying claims for skin cancer removal when the patient presented a second time for closure. The AADA reached out to its Aetna contacts and provided examples of denied claims. Aetna acknowledged its mistake, fixed it, and implemented training for its claims processing team on modifier 58 to avoid future incorrect denials.

Learn more about the Academy’s private payer advocacy efforts.