This waiver may remain in place in states where mandated. This waiver may remain in place in states where mandated. In addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members. And other FAQs. Any use of CPT outside of Aetna Clinical Policy Bulletins (CPBs) should refer to the most current Current Procedural Terminology which contains the complete and most current listing of CPT codes and descriptive terms. Who the tests are for (self or dependent), Your pharmacy plan should be able to provide that information. COVID-19 Patient Coverage FAQs for Aetna Providers Those who have already purchased . Beginning January 15, 2022, individuals with private health insurance coverage or covered by a group health plan who purchase an over-the-counter COVID-19 diagnostic test authorized, cleared, or approved by the U.S. Food and Drug Administration (FDA) will be able to have those test costs covered by their plan or insurance. Treating providers are solely responsible for medical advice and treatment of members. (Offer to transfer member to their PBMs customer service team.). Aetna Better Health plan pricing may be determined by each individual health plan in accordance with its state contracts. The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. You should expect a response within 30 days. The discussion, analysis, conclusions and positions reflected in the Clinical Policy Bulletins (CPBs), including any reference to a specific provider, product, process or service by name, trademark, manufacturer, constitute Aetna's opinion and are made without any intent to defame. Some subtypes have five tiers of coverage. Medicare Sets COVID-19 Testing Reimbursement Amounts By clicking on I Accept, I acknowledge and accept that: The Applied Behavior Analysis (ABA) Medical Necessity Guidehelps determine appropriate (medically necessary) levels and types of care for patients in need of evaluation and treatment for behavioral health conditions. . Coverage is in effect, per the mandate, until the end of the federal public health emergency. To make sure I didn't have COVID, I purchased a COVID test kit from Walgreens . Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. For all Aetna-insured Commercial plans, Aetna waived member cost-sharing for inpatient admissions for treatment of COVID-19 or health complications associated with COVID-19 through February 28, 2021. You are not eligible if you have Medicare, Medicare Supplement, Medicaid, or voluntary insurance. CPT only copyright 2015 American Medical Association. The policy aligns with the Families First and CARES legislation and regulations requiring all health plans to provide coverage of COVID-19 testing without cost share. Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its affiliates (Aetna). The information contained in this FAQ is subject to change at the discretion of CVS at any time, for any reason and without advanced notice. Please call your medical benefits administrator for your testing coverage details. . For example, Binax offers a package with two tests that would count as two individual tests. CVS Health currently has more than 4,800 locations across the country offering COVID-19 testing. Providers will bill Medicare. Even if the person gives you a different number, do not call it. How to get your At-Home Over-The-Counter COVID-19 Test for Free No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. How to Submit Your At-Home COVID Test to Your Insurance Company - MSN HCPCS code. At-home COVID Test Kit Reimbursement for Aetna members Pharmacists, in partnership with other health care providers, are well positioned to aid COVID-19 testing expansion. COVID test: How to get free at home tests with insurance reimbursement No fee schedules, basic unit, relative values or related listings are included in CPT. The member's benefit plan determines coverage. Once completed you can sign your fillable form or send for signing. Members must get them from participating pharmacies and health care providers. This search will use the five-tier subtype. Treating providers are solely responsible for dental advice and treatment of members. You pay nothing for a diagnostic test during the COVID-19 public health emergency when you get it from a laboratory, pharmacy, doctor, or hospital, and when Medicare covers this test in your local area. For the time being, you'll have to submit a claim to get reimbursed after you buy tests. The COVID-19 At-Home Test Reimbursement form is 1 page long and contains: It will show you whether a drug is covered or not covered, but the tier information may not be the same as it is for your specific plan. Aetnas health plans do not cover serological (antibody) tests that are for purposes of: return to work or school or for general health surveillance or self-surveillance or self-diagnosis, except as required by applicable law. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. Coronavirus (COVID-19) resources | Aetna Medicaid Illinois Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. This includes those enrolled in a Medicare Advantage plan. Get the latest updates on every aspect of the pandemic. Refer to the CDC website for the most recent guidance on antibody testing. Testing will not be available at all CVS Pharmacy locations. COVID-19 home test kit returns will not be accepted. CVS Health is uniquely positioned to play a vital role in supporting local communities and the overall health care system in addressing the COVID-19 pandemic. New and revised codes are added to the CPBs as they are updated. Your benefits plan determines coverage. However, you will likely be asked to scan a copy of . The conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered (i.e., will be paid for by Aetna) for a particular member. Note: Each test is counted separately even if multiple tests are sold in a single package. If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. In March, CVS Health opened a pilot drive-through COVID-19 test site in a parking lot at a CVS Pharmacy store in Shrewsbury, MA. These tests dont require an order from your physician to qualify for reimbursement, although tests ordered by a provider arent subject to the frequency limit. Tests must be used to diagnose a potential COVID-19 infection. The AMA disclaims responsibility for any consequences or liability attributable or related to any use, nonuse or interpretation of information contained in Aetna Clinical Policy Bulletins (CPBs). For members with Aetna pharmacy benefits, you can submit a claim for reimbursement through your Aetna member website. They should check to see which ones are participating. You can use this money to pay for HSA eligible products. Aetna Better Health will cover the treatment of COVID-19 or health complications associated with COVID-19. To ensure access for COVID-19 testing and have consistent reimbursement, Aetnawill reimburse contracted and non-contracted providers for COVID-19 testing as follows in accordance with the members benefit plan3. A parent or legal guardian must complete the on-line registration for all minor patients, and patients 3 to 15 years of age must be accompanied by a parent or legal guardian when they come to be tested. Yes, patients must register in advance at CVS.comto schedule an appointment. CPT is developed by the AMA as a listing of descriptive terms and five character identifying codes and modifiers for reporting medical services and procedures performed by physicians. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this product. Send it to the address shown on the form. The requirement also applies to self-insured plans. Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. Medicare covers the vaccine for anyone who has Medicare due to their age, a disability, End-Stage Renal Disease (ESRD), or ALS (also called . This Agreement will terminate upon notice if you violate its terms. If as part of that visit the provider administers or orders a test for influenza, strep, or other respiratory infection, that additional testing will also be covered without member cost sharing. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites. This information is available on the HRSA website. Prior to COVID-19, testing for infectious diseases were included in the rate for surgical procedures and that policy will continue during the COVID-19 pandemic. This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. Please note also that the ABA Medical Necessity Guidemay be updated and are, therefore, subject to change. Aetna is reaching out to the commercial labs about their ability to provide the COVID-19 testing. Go to the American Medical Association Web site. Please note that copays, deductibles and coinsurance will apply according to the members benefit plan. Tests must be FDA-authorized. You, your employees and agents are authorized to use CPT only as contained in Aetna Clinical Policy Bulletins (CPBs) solely for your own personal use in directly participating in healthcare programs administered by Aetna, Inc. You acknowledge that AMA holds all copyright, trademark and other rights in CPT. Also, new federal guidelines allow members with private, employer-sponsored and student health commercial insurance to request reimbursement for over-the-counter COVID-19 diagnostic tests that are purchased on or after January 15, 2022 without physician's orders 1.This mandate is in effect until the end of the federal . Your plan may require reasonable documentation of proof of purchase with a claim for reimbursement for the cost of an OTC COVID-19 test. Aetna generally does not reimburse doctors and dentists for Personal Protection Equipment. Children age 3 years and older are now eligible for testing at all of our COVID-19 drive-thru and rapid-result testing sites located at select CVS Pharmacy locations, effective March 5, 2021. This mandate is in effect until the end of the federal public health emergency. The Biden Administration said it will make sure every insured American can get a reimbursement by around Jan. 15. . Tests must be purchased on or after January 15, 2022. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. The requirement also applies to self-insured plans. The test will be sent to a lab for processing. PDF Aetna - Medicare Medical Claim Reimbursement Form How will I be reimbursed for rapid COVID tests? And other FAQs For language services, please call the number on your member ID card and request an operator. Home Test Kit Reimbursement. Commercial labs are in the process of updating their provider community about their capabilities and how to order tests. During the COVID-19 PHE, get one lab-performed test without a health care professional's order, at no cost. Penn Health Insurance and COVID-19 - PublicWeb Others have four tiers, three tiers or two tiers. In Vitro Diagnostics EUAs - Antigen Diagnostic Tests for SARS-CoV-2 Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its affiliates (Aetna). Coronavirus (COVID-19) Resource Center | Cigna While the Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. Go to the pharmacy website or call the relevant pharmacy to confirm participating locations and get details on how to order. Due to high demand for OTC at-home COVID-19 tests, supplies may be limited in some areas. 2020 claims eligible for the 20% increase in the MS-DRG weighting factor will also be required to have a . Others have four tiers, three tiers or two tiers. This applies whether you purchased your health . A list of approved tests is available from the U.S. Food & Drug Administration. *The content below is not intended to be a substitute for professional medical advice, diagnosis or treatment. The policy . Our ability to coordinate the availability of COVID-19 testing bolsters states efforts to manage the spread of the virus. Members should not be charged for COVID-19 testing ordered by a provider acting within their authorized scope of care or administration of a COVID-19 vaccine. Please refer to the FDA and CDC websites for the most up-to-date information. The tests come at no extra cost. Claims for reimbursement for at home COVID-19 tests may be submitted online or via mail using the printable form. Members will need to submit a claim for reimbursement through the Aetna website and will receive a check once the claim is approved. Some pharmacies may not be able to process claims for OTC COVID-19 tests at the pharmacy counter. Parents or guardians seeking testing for children under the age of 10 (or the age of 5 for rapid-result testing) should consult with a pediatrician to identify appropriate testing options. The following rates are used for COVID-19 testing for commercial and Medicare plans, unless noted otherwise: Diagnostic testing/handling rates - Medicare. They should check to see which ones are participating. The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. ", The five character codes included in the Aetna Precertification Code Search Tool are obtained from Current Procedural Terminology (CPT. The new states are Alabama, Arkansas, Colorado, Delaware, Iowa, Mississippi, Montana, North Dakota, Oregon and West Virginia. If you purchase a test outside of your preferred network, your insurance company can cap your reimbursement fee at $12meaning that even if your COVID test costs upwards of $30, you will still . You may opt out at any time. Members and their providers will need to consult the member's benefit plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply. However, applicable state mandates will take precedence with respect to fully insured plans and self-funded non-ERISA (e.g., government, school boards, church) plans. Important: Use your Aetna ID that starts with a "W.". Since Clinical Policy Bulletins (CPBs) can be highly technical and are designed to be used by our professional staff in making clinical determinations in connection with coverage decisions, members should review these Bulletins with their providers so they may fully understand our policies. The information you will be accessing is provided by another organization or vendor. Under the federal governments current guidelines, tests are eligible if: Eligible tests include single-use, cartridge-based tests (for example, Flowflex, BinaxNow or Ongo). Per guidance from the Centers for Medicare & Medicaid Services (CMS), the Department of Labor and the Department of the Treasury, all Commercial, Medicaid and Medicare plans must cover COVID-19 serological (antibody) testing with no cost-sharing. Disclaimer of Warranties and Liabilities. For people . As an Aetna member, per the Federal Government, you are eligible for insurance reimbursement under a qualified plan for FDA-authorized COVID-19 at-home tests purchased on or after January 15. Home test kits may be eligible for reimbursement through OptumRx if the test was purchased after January 15, 2022. COVID-19 Over-the-Counter Test Reimbursement Form - OptumRx The AMA is a third party beneficiary to this Agreement. Recently, the United States government made available four free at-home COVID-19 tests to each home address upon request. This is all part of our overall strategy to ramp-up access to easy-to-use, at-home tests at no cost," said U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra, in a . Members and their providers will need to consult the member's benefit plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply. Biden free COVID tests plan. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Postal Service. In the event that a member disagrees with a coverage determination, member may be eligible for the right to an internal appeal and/or an independent external appeal in accordance with applicable federal or state law. The responsibility for the content of Aetna Clinical Policy Bulletins (CPBs) is with Aetna and no endorsement by the AMA is intended or should be implied. As for the eight-test maximum, a family of four covered under the same plan could be reimbursed for up to 32 tests per 30-day period. The AMA disclaims responsibility for any consequences or liability attributable or related to any use, nonuse or interpretation of information contained in Aetna Clinical Policy Bulletins (CPBs). the labs to efficiently report and track testing services related to SARS-CoV-2 and will streamline the reporting and reimbursement for this test in the US. For now, the only submission instructions are to fax the completed form to 859-410-2422 or physically mail it along with any receipts to the address on the back of your health insurance card. Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search. For example, some UnitedHealthcare plans cover up to $40 of OTC products per quarter, which would cover the cost of 3 COVID-19 tests every 3 months (based on the $12 reimbursement rate being used . COVID-19 Testing, Treatment, Coding & Reimbursement - UHCprovider You can only get reimbursed for tests purchased on January 15, 2022 or later. The member's benefit plan determines coverage. Please be sure to add a 1 before your mobile number, ex: 19876543210. The test can be done by any authorized testing facility. This allows us to continue to help slow the spread of the virus. HCPCS U0003: $100 per test (Commercial plans only), HCPCS U0003: $75 per test (Medicare plans only), HCPCS U0004: $100 per test (Commercial plans only), HCPCS U0004: $75 per test (Medicare plans only), HCPCS U0005: $25 per test (Medicare plans only)*. LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). Disclaimer of Warranties and Liabilities. Health benefits and health insurance plans contain exclusions and limitations. Links to various non-Aetna sites are provided for your convenience only. Sign in or register at Caremark.com (You must be a CVS Caremark member) Aetna Better Health members with questions about these specific benefits are encouraged to call the member services phone number on the back of their ID cards. Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. Meanwhile, the agency said that Medicare pays for Covid-19 tests performed by a laboratory at no cost when the test is ordered by a physician or other health care provider. In addition, a member may have an opportunity for an independent external review of coverage denials based on medical necessity or regarding the experimental and investigational status when the service or supply in question for which the member is financially responsible is $500 or greater. These guidelines do not apply to Medicare. Routine testing for influenza, strep, and other respiratory infections without a COVID-19 test will be covered subject to applicable cost sharing under the members plan. 2Disclaimer: Regulations regarding testing for Aetna Medicaid members vary by state and, in some cases, may change in light of the current situation. Reimbursement. CPT only copyright 2015 American Medical Association. It will show you whether a drug is covered or not covered, but the tier information may not be the same as it is for your specific plan. Last update: February 1, 2023, 4:30 p.m. CT. OTC COVID-19 tests can be purchased at pharmacies, retail locations or online.