Aetna Data Nuances

Aetna will often copy/paste the same NPI list for multiple rate tiers for a given code and billing class. This leads to rate ambiguity and makes it seem as if multiple rates exist for the same NPIs, and it can also affect aggregate distributions. Example 1 within this blog explains how to filter through this noise: https://www.serifhealth.com/blog/understanding-behavioral-health-reimbursement-transparency-data-trends-and-tactics .

Aetna’s policy states that their NP-level rate is 85% of the PhD-level rate, and their Master’s-level rate is 75% of the PhD-level rate, which allows you to pick the correct rate.

If you are looking for a therapy code (e.g., 90837) and Master's rate, we'd recommend multiplying the max rate by 0.75 to get Master's.