Colorado: We’re updating our fee schedule

Beginning October 15, 2022, we’ll adjust our standard fee schedule (the Aetna® Market Fee Schedule, or AMFS) for all plans in the Colorado market. This change affects those services for which we pay you based on AMFS. You can find these services in the compensation section of your contract.

Please note: If you have a different fee-based schedule, these adjustments apply only to the default.

How we develop fee schedules

For CPT® codes, we look at industry-standard methodologies and sources, such as the 2022 Resource-Based Relative Value Scale (RBRVS). These sources include Outpatient Prospective Payment System (OPPS) rates that the Centers for Medicare & Medicaid Services (CMS) establishes (CMS Clinical Laboratory Fee Schedule).

When we use the RBRVS, we base the fee schedule on a multiplier of 34.6062. We use the 2022 Relative Value Units (RVUs) file that CMS posts on its website.

For codes using the RBRVS, we use the “site-of-service” differential, which CMS defines in transitional RVUs. This differential adjusts payment for certain codes based on where you perform a service. To find code-specific information where we use the RBRVS and the 2022 formula for calculating the physician fee schedule, visit the Centers for Medicare & Medicaid Services (CMS).

For some codes for which we don’t use the RBRVS or when information isn’t available, we use other sources to develop the fees. These sources include external vendor pricing models, Medicare fee schedules and nationally contracted rates.

We also adjust fees based on the Colorado Medicare Geographic Price Cost Index (GPCI). We won’t apply any other changes that the CMS makes in 2022 except for new codes that Medicare values.

To get the full RBRVS schedule:

• Call the Government Publishing Office at 1-202-512-1800.
• Visit the Centers for Medicare & Medicaid Services (CMS).

Get the updated AMFS online as of October 15, 2022

Physicians, you can always check your current fee schedule on our Availity provider portal,* and your updated fee schedule will be available beginning October 1, 2022. Once you’re logged in to Availity®, click on Claims & Payments > Fee Schedule Listing.

Please note: Only contracted physicians can access fee schedules.

• Fee schedules are not available to an office classified as a hospital, ancillary or IPA/PHO; to an office with a billing setup; or to behavioral health providers who are not MDs/DOs. Fees displayed are based on contracted amounts negotiated for specified treatments. They reflect the amounts allowed for services as if Aetna is paying each ASA/CPT/HCPCS code on a line-by-line, fee-for-service basis.
• ACO organizations: Fee schedule information will not display accurate rates for services provided to Aetna members who participate in an accountable care organization (ACO) arrangement. A member with an ACO arrangement will have a member ID card with an ACO logo and/or network name. You should use the Cost Estimator tool to estimate costs for these patients.

If you need your updated fee schedule before it’s online or if you’re a non-physician provider, fax your request and the CPT codes to 1-859-455-8650 after October 15, 2022.

If you have questions, call the Provider Contact Center at 1-888 MD AETNA (1-888-632-3862) (TTY: 711).

Thank you for your continued participation in the Aetna network.

*Availity is available only to U.S. providers and its territories.