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Aetna Better Health of Virginia·VA · Endocrinology, Family Medicine, Internal Medicine +2 more·Provider Notification
Effective date
Jan 1, 2025
We identified it
Aug 13, 2026
Summary
Aetna Better Health of Virginia is discontinuing its CPT Category II code incentive program effective January 1, 2025. Providers will no longer receive the $25 per-code reimbursement for claims with dates of service in 2025, though 2024 claims submitted by February 1, 2025 will still receive payment. Billing teams must stop expecting incentive payments and adjust revenue projections accordingly.
Action Required
By February 1, 2025: Billing team must submit all outstanding 2024 claims with CPT Category II codes (0500F, 0501F, 0502F, 0503F, 2022F, 2023F, 2024F, 2025F, 3044F, 3051F, 3052F, 3072F, 3074F, 3075F, 3077F, 3078F, 3079F, 3080F) to Aetna Better Health Virginia to capture remaining $25 incentive payments; submissions after this deadline will not receive incentive reimbursement. Effective January 1, 2025: Update billing system to remove $25 incentive expectation for all new 2025 claims; continue appending CPT II codes for HEDIS performance measurement and quality tracking purposes (codes are still clinically valuable for gap identification, even without payment). Notify providers and clinical staff that CPT II codes should still be documented for Comprehensive Diabetes Care and Controlling High Blood Pressure measures but will no longer generate additional revenue. Update revenue projections to account for loss of $25 per-code incentive income. Contact Aetna Better Health Provider Relations at 1-800-279-1878 if claims from 2024 are rejected after February 1, 2025.