MedicaidCoverageHigh impact
Provider Notification - New State Policies for Virginia Medicaid
Aetna Better Health of Virginia·VA · Audiology, Physical Therapy, Occupational Therapy +3 more·Provider Notification
Effective date
Jan 1, 2025
We identified it
Aug 13, 2026
Summary
Aetna Better Health of Virginia implemented new unit limitations and frequency restrictions for durable medical equipment (wheelchair supplies, heat application devices, TENS/NMES equipment) and audiology services effective January 1, 2025. This is a CORRECTION to the original January 1 notification clarifying that unit limitations apply only to claims billed without modifiers RR and U1, which are excluded due to Service Authorization requirements. Additionally, codes 92567 and 92568 will now deny when billed on the same date of service as code 92550.
Action Required
Immediately: Billing team must update billing system with the following rules for Virginia Medicaid (Aetna Better Health of Virginia): (1) Wheelchair supply codes—implement unit/frequency limits per policy (E0978: 1 unit/36 months; E0953-E0954, E0951-E0952, E1016, E2209, K0020, K0038-K0039, E0995, E2381-E2387, K0019: 2 units/24 months; K0015-K0018, K0051-K0052: 2 units/36 months; E0982: 1 unit/24 months); (2) Heat/TENS/NMES codes—implement limits (E0210, E0215, E0217: 1 unit/60 months); (3) Configure system to allow claims with modifiers RR and U1 to bypass unit limitations for these codes due to Service Authorization requirements; (4) Audiology—configure denial rule to prevent codes 92567 and 92568 from being paid when billed on same date of service as 92550. Update encounter templates and staff training to reflect frequency restrictions. Failure to implement will result in claim denials and payment delays. Contact Aetna Better Health Provider Services at 1-800-279-1878 (TTY: 711) with questions.