Aetna Cutting Lab Rates Well Below Medicare

Aetna is putting pressure on its laboratory network, demanding payment reductions for commercial work substantially below Medicare rates.According to a letter Aetna sent to providers obtained by Laboratory Industry Report, Aetna invoked the new market fee schedule back in January, although it had to renotify providers in March because of unspecified communication issues. It began applying the new schedule June 1.The letter was accompanied by a sample fee schedule that included professional component pathology rates for the Dallas area. The rates range from 30 percent to 50 percent below what Medicare is paying, even taking into consideration recent cuts the Centers for Medicare and Medicaid Services made to pathology services. “Aetna’s new baseline is substantially lower,” said Eric Bettinger, chief financial officer of ClearPath Diagnostics in Syracuse, N.Y. He and other industry observers are concerned that this will embolden other carriers to cut their reimbursement as well. Aetna officials declined to discuss its specific rates, citing the need for confidentiality. But it did confirm in a statement that “CMS reduced rates on the Medicare fee schedule for surgical pathology fees so we made a corresponding adjustment to the base national fee schedule.” Aetna also noted that its national fee schedule has been below Medicare rates for years. “Aetna continuously monitors coding changes with Medicare/Medicaid fee schedule changes and we will adjust our national fee schedule as appropriate.” For a closer look at the contracting environment for laboratories and health plans see Inside the Laboratory Industry beginning on page 4.

Aetna’s Test Pricing
CPT Code	Procedure	Aetna Price	2013 Medicare Rate
88300	Surgical pathology, gross	$2.65	$4.41
88302	Tissue exam	$3.89	$6.82
88304	Tissue exam	$6.58	$11.30
88305	Tissue exam	$21.86	$37.10
Source: Aetna and CMS