Aetna Billing Guide for Therapists and Psychiatrists

Aetna is a national health insurer owned by CVS Health. For a therapy or psychiatry practice, the daily questions are simple. Which payer ID do I use? Where do disputes go? Who do I call? This page answers them, with the source and the date we checked each fact.

Checked 10/1/26. Payer rules change. Confirm anything high-stakes in Availity or with Aetna before you rely on it.

Aetna at a glance

Which states does Aetna serve?

Aetna does not publish one state-by-state list on its provider pages. What we could confirm, state by state, is below. Always read the member's ID card to see which Aetna plan and which state rules apply.

• Aetna Better Health (Medicaid managed care). Aetna's Aetna Better Health homepage lists plans in Florida, Illinois, New York and Texas among the ten states MCM South serves. It does not list Georgia, Massachusetts, Connecticut, Colorado, Tennessee or North Carolina.
• ACA marketplace (individual) plans. CVS announced it is leaving the ACA individual market for 2026. Illinois's exchange confirms Aetna plans end there on January 1, 2026 (Get Covered Illinois). Trade press reports about 1 million members across 17 states (Healthcare Dive).
• State-specific provider rules. Aetna posts separate provider rules for Colorado, Connecticut, Florida, Illinois, Massachusetts, New York and Texas on its state regulation page. It posts none for Georgia, Tennessee or North Carolina.

"Not listed" means the page did not show it on 10/1/26. It is not a statement that Aetna sells nothing there.

Payer IDs and the plans under each one

A payer ID is the code that routes an electronic claim to the right insurer. Using the wrong one is a common reason claims reject before Aetna ever sees them.

Where claims, disputes and appeals go

Paper claims. Aetna's own guidance is to mail claims to the address on the back of the member's ID card. Aetna does not publish one national claims PO box in the guides we opened. Submit electronically when you can.

Disputes and appeals (private payer). Aetna's Provider Resolution Team takes written disputes. The address depends on your state (Aetna disputes and appeals overview):

• Non-Medicare disputes: 1-888-632-3862. Medicare disputes: 1-800-624-0756.
• Reconsideration is due within 180 calendar days of the initial decision. The appeal after that is due within 60 calendar days of the reconsideration decision.
• Some states give providers more time on fully insured plans (Aetna lists Colorado, Georgia, North Carolina and Tennessee among its exceptions, and Texas providers have a longer window under Texas rules). Read Aetna's provider appeals page for your state before you count days.

Timely filing (the deadline to submit a first claim). It depends on your Aetna contract. Check your agreement and Aetna's provider manual. Do not rely on a number you read on a blog.

Behavioral health: how Aetna handles it

• Private payer. Aetna Behavioral Health is an internal business unit of Aetna, not a separate vendor (Aetna BH provider manual). Aetna lists a June 2026 Provider and Behavioral Health Manual on its manuals page. Employee Assistance Program (EAP) rules are in a separate EAP Manual there.
• Credentialing. You complete a participation request, then Aetna pulls your profile from CAQH ProView (the Council for Affordable Quality Healthcare's shared provider database). You must authorize Aetna in CAQH. Recredentialing runs every three years per Aetna's manual.
• Prior authorization. Aetna's outpatient list includes partial hospitalization, ABA (applied behavior analysis) and TMS (transcranial magnetic stimulation, 90867-90869). Submit through Availity or AetnaElectronicPrecert.com. The list we opened is dated 8/1/2024, so check the current version (Aetna BH precert list).
• Psychiatrists. Medication management is billed with E/M (evaluation and management) codes plus psychotherapy add-on codes. See our CPT and E/M code guide.
• Telehealth (Texas fully insured plans only). Aetna's Texas telemedicine page lists modifiers GT and 95 with place of service 02 (Aetna Texas telemedicine). We did not find a national Aetna telehealth billing policy. Do not apply the Texas rule to other states.

Medicare, Medicaid and state law: keep them separate

• Medicare Advantage (Aetna Medicare). Aetna's Medicare PPO guide uses payer ID 60054 and the Medicare line 1-800-624-0756. Medicare rules come from CMS. They are not the same as Aetna's commercial rules.
• Medicaid (Aetna Better Health). Each state's plan has its own payer ID, address and deadlines. Illinois plan claims have a 180-day filing limit on the Aetna Better Health Illinois claims page. That limit does not carry to any other state.
• State law. Insurance departments set rules that sit on top of Aetna's. Texas is one example: Aetna lists Texas Insurance Code Chapter 1455 for telemedicine on the page above. Look up your state regulator in the table.

What to do Monday morning

1. Pull the member's ID card. Note the plan name and any payer ID printed on it.
2. Run eligibility in Availity before the first visit.
3. Submit claims electronically under the payer ID on the card. Use 60054 only when the card or Aetna's guide points there.
4. Calendar the dispute window the day a denial arrives. Do not wait.
5. If a claim rejects for payer ID, stop. Check the state's Aetna Better Health site before resubmitting.

How MCM South handles Aetna billing

MCM South bills Aetna for psychotherapists and psychiatrists. We verify benefits before the first session, submit claims electronically, follow up on denied and rejected claims, file appeals, and work secondary claims. We also handle insurance credentialing. Get a free quote.

Frequently asked questions

What is Aetna's payer ID?

Aetna's commercial and Medicare payer ID is 60054, per Aetna's March 2026 Medicare PPO quick reference guide. Aetna Better Health of Texas uses 38692. Other Aetna Better Health plans use their own IDs, so check the state's provider site.

Where do I mail Aetna claims?

Use the address on the back of the member's ID card. Aetna's guidance does not give one national PO box. Electronic submission through Availity avoids the question.

How long do I have to appeal an Aetna denial?

Send a reconsideration within 180 calendar days of the initial decision. If you disagree with that result, file an appeal within 60 calendar days. Some states allow longer on fully insured plans.

Does Aetna manage behavioral health itself?

Yes, in the manual we opened. Aetna Behavioral Health is an internal Aetna business unit. EAP plans have their own manual on Aetna's provider site.

Sources (checked 10/1/26)

Aetna provider site; Aetna Medicare PPO quick reference (03/26); Aetna disputes and appeals pages; Aetna BH provider manual; Aetna Better Health state sites; Get Covered Illinois; Healthcare Dive; state insurance regulator sites. Full links inline above.

Related guides: Private Insurances hub · Billing Terms Glossary · Who We Serve · All resources.