Aetna Coverage

 We’re In-Network with most Aetna plans! To ensure transparency, please see the Aetna billing guide below.

 

Call Aetna and ask: "What is the patient responsibility for each of these codes?"

They'll tell you there are "6 free visits" but that's no longer the case.

It's essential to ask about the specific codes.

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For visits where parent is lactating and baby is assessed, both individuals are billed. When parent is pumping and we are not assessing oral function at breast and/or bottle, only parent is billed. When parents are bottle feeding without lactating, only baby is billed. 

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Mom Codes:

Z39.1 + S9443 (billed at each visit, home and office)

Z39.1 + 99404 (mom office)

Z39.1 + 99344 (mom home initial)

Z39.1 + 99349 (mom home followup)

Baby Codes:

P92.5 + S9443 (billed at each visit, home and office)

P92.5 + 99403 (baby home, 90 min visit)

P92.5 + 99404 (baby home, 2h visit)

 

Rough Cost Estimates (Varies by Plan). There are not a guarantee of costs.

 

VISITS 1-3

Total for Mom and Baby for Office: $0, most plans, 60 minute visit

Total for Mom and Baby for Home: the cost of baby's 99403 $7-90

 

VISITS 4++

Total for Mom and Baby for Office: $71.50 (mom) + $71.50 (baby) for 60 minute visit

Total for Mom and Baby for Home: $71.50 (mom) + $71.50 (baby) + the $7-$90 cost of 99403

 

 Questions? Text 760-289-0142. I am happy to answer questions, though Aetna can confirm your costs.

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Once you have confirmed your coverage and the portion you might be responsible for, you may book by following the link below.

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