Question 1

What is a Aetna fee schedule?

Accepted Answer

A Aetna fee schedule is the contracted reimbursement rate that Aetna pays an in-network provider for a specific service, identified by CPT, HCPCS, Revenue Code, or MS-DRG. Because Aetna is a federation, rates vary by licensee (e.g. Anthem, Highmark, Florida Blue), by plan type (PPO, HMO, POS), and by provider contract. PayerPrice consolidates schedules from every Aetna release into one searchable view.

Question 2

How do I look up my Aetna fee schedule?

Accepted Answer

Traditionally, providers request rate sheets through their Aetna provider portal, Availity, or by faxing the local plan — a process that typically returns a partial PDF and can take 2–6 weeks. PayerPrice skips this entirely: Aetna's machine readable files are pulled monthly under the Transparency in Coverage Rule and surfaced as searchable rates per CPT × NPI × Tax ID × region.

Question 3

How much does Aetna reimburse for 99214?

Accepted Answer

National-average Aetna reimbursement for CPT 99214 (established-patient office visit, moderate complexity) is not yet available in our latest pull, with the exact amount varying by plan, region, and provider contract. That is comparable to the corresponding Medicare allowed amount.

Question 4

What are Aetna machine readable files?

Accepted Answer

Machine readable files (MRFs) are digital, monthly-refreshed files that Aetna is legally required to publish under the Transparency in Coverage Rule (effective July 2022). They contain every in-network negotiated rate and every out-of-network allowed amount for every contracted provider. They are technically public but practically unusable — single files routinely exceed 100 GB and span billions of rows.

Question 5

How do Aetna reimbursement rates compare to Medicare?

Accepted Answer

Commercial Aetna rates typically sit in the 120–160% of Medicare range for E&M codes, with imaging and surgical codes often paying 150–200% of Medicare. The exact multiple varies sharply by plan and by specialty. PayerPrice surfaces the multiple per row so you can negotiate on a like-for-like basis.

Question 6

How can I negotiate higher Aetna reimbursement rates?

Accepted Answer

Strong Aetna negotiations rest on three pieces of evidence: (1) what Aetna pays comparable providers in your market for your top 20 revenue codes, (2) how your current rates compare to the in-market 50th, 75th, and 90th percentiles, and (3) the year-over-year drift of those benchmarks. PayerPrice lets you assemble all three in an afternoon rather than a quarter.

Payer Type	National commercial payer (CVS Health)
Total Membership
Market Share
Plan Types	HMO PPO POS EPO Medicare Advantage ASA
Plans Tracked in PayerPrice
Data Source	Machine Readable Files (TiC Rule)
Data Freshness	Updated monthly

CPT	Description	Category
99214	Office Visit, Established (Moderate)	E&M	View rates
99213	Office Visit, Established (Low)	E&M	View rates
99215	Office Visit, Established (High)	E&M	View rates
90837	Psychotherapy, 60 min	Psychiatry	View rates
90834	Psychotherapy, 45 min	Psychiatry	View rates
90791	Psychiatric Diagnostic Evaluation	Psychiatry	View rates
70450	CT Head/Brain without Contrast	Radiology	View rates
73721	MRI Lower Extremity Joint	Radiology	View rates
45378	Diagnostic Colonoscopy	Surgery	View rates

Negotiating with Aetna— Benchmarking Fee Schedules & Reimbursement Rates 2026

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Aetna rates for the most-searched CPT codes

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Aetna fee schedules — questions providers ask us

See exactly what Aetna pays your competitors.