Aetna drops pathology reimbursement on Market Fee Schedule to ~70% of Medicare rates

Aetna is dropping reimbursement for pathology services to approximately 70% of Medicare rates for its Market Fee Schedule (AMFS), effective September 1, 2014. The AMFS is Aetna’s out-of-network rates, but according to the Aetna website, it is also the starting point for contract negotiations with its in-network doctors. This means this change will also significantly impact all pathologists and laboratories that contract with Aetna. Aetna first looks at what Medicare pays for services as well as local market factors and then determines the AMFS. The AMFS is changing in the Ohio market only on September 1st. Typically the AMFS Schedule changes nationally but it’s done state by state since it’s based off of Medicare. So it’s possible Ohio will go active with the updated schedule before Florida or a different state. The link above includes reimbursement for many clinical pathology tests as well as radiology services.