Aetna makes no representations and accepts no liability with respect to the content of any external information cited or relied upon in the Clinical Policy Bulletins (CPBs). For example, Binax offers a package with two tests that would count as two individual tests. National labs will not collect specimens for COVID-19 testing. 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. Some subtypes have five tiers of coverage. 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). Aetna will cover up to eight (8) over the counter (OTC) at-home COVID-19 tests per 30-day period for each person covered under your plan. LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). CVS Health At Home COVID-19 Test Kit; Walgreens At-Home COVID-19 Test Kit; 12/23/2022: Abbott Diagnostics Scarborough, Inc. BinaxNOW COVID-19 Antigen Self Test 03/31/2021: You can find a partial list of participating pharmacies at Medicare.gov. The policy aligns with Families First and CARES Act legislation and regulations requiring all health plans to provide coverage of COVID-19 testing without cost share. Note: Each test is counted separately even if multiple tests are sold in a single package. Participating pharmacies offering COVID-19 Over-the-Counter (OTC) tests The following is a partial list of pharmacies participating in the Medicare COVID-19 Over-the-Counter (OTC) tests initiative. Aetna will cover up to eight (8) over the counter (OTC) at-home COVID-19 tests per 30-day period for each person covered under your plan. Subject to applicable law, Aetna may deny tests that do not meet medical necessity criteria. The tests, part of the administration's purchase of 500 million tests last . 1-800-557-6059 | TTY 711, 24/7. Yes, Aetna will cover tests approved, cleared or authorized by the U.S. Food and Drug Administration. The CDC recommends that anyone: who has symptoms of COVID-19 who has been in close contact with a person known to have COVID-19: or who lives in or has recently traveled from an area with ongoing spread of COVID-19, should contact their health care provider and be tested. Laboratories using the test developed by the Center for Disease Control and Prevention (CDC) would be reimbursed $36 per test. Starting January 15, most people with a health plan can go online, or to a pharmacy or store to purchase an at-home over-the-counter COVID-19 diagnostic test authorized by the U.S. Food and Drug Administration (FDA) at no cost, either through reimbursement or free of charge through their insurance. If you do not intend to leave our site, close this message. . Due to high demand for OTC at-home COVID-19 tests, supplies may be limited in some areas. These forms are usually returned by mail, and you'll most likely find the address for where to mail it on the form itself. Beginning in September 2021, we have added a select number of new testing locations in 10 new states to increase access to COVID-19 testing in high-risk, underserved communities with limited availability to lab testing services. Access trusted resources about COVID-19, including vaccine updates. The requirement also applies to self-insured plans. There are two main ways to purchase these tests. Insurance companies are still figuring out the best system to do . Members should take their red, white and blue Medicare card when they pick up their tests. Please note: Your receipt must be dated January 15, 2022 or later to be eligible for reimbursement. Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. They should check to see which ones are participating. Refer to the CDC website for the most recent guidance on antibody testing. Americans with health insurance can get up to eight at-home coronavirus tests for free thanks to a new requirement. You can find a partial list of participating pharmacies at Medicare.gov. Medicare covers the updated COVID-19 vaccine at no cost to you. 1Aetna will follow all federal and state mandates for insured plans, as required. As of April 4, 2022, members with Medicare Part B can get up to eight over-the-counter COVID-19 tests each month while the COVID-19 public health emergency lasts. 5. Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. Kaiser members can go to " Coverage & Costs " and select "Submit a medical claim.". Save your COVID-19 test purchase receipts. This includes those enrolled in a Medicare Advantage plan. Aetna is working to protect you from COVID-19 scams. . 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. The tests come at no extra cost. For language services, please call the number on your member ID card and request an operator. Links to various non-Aetna sites are provided for your convenience only. All Rights Reserved. 4. By clicking on I accept, I acknowledge and accept that: Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". Each main plan type has more than one subtype. Tests used for employment, school or recreational purposes are not eligible for reimbursement unless required by state law. Links to various non-Aetna sites are provided for your convenience only. Members must get them from participating pharmacies and health care providers. Do not give out your Aetna member ID number or other personal information. 160.103 in that the program has no relationship with individuals that would legally obligate the program to pay claims for some or all of the health care . Those using a non-CDC test will be reimbursed $51 . These guidelines do not apply to Medicare. The AMA disclaims responsibility for any consequences or liability attributable or related to any use, nonuse or interpretation of information contained in Aetna Precertification Code Search Tool. 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. 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. 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. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. Your benefits plan determines coverage. Please visit your local CVS Pharmacy or request . 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. Applicable FARS/DFARS apply. Medical Reimbursement: COVID Over-the-Counter Test Form (PDF) . Aetna Medicaid Illinois is here for you during the coronavirus (COVID-19) pandemic, no matter what. The five character codes included in the Aetna Clinical Policy Bulletins (CPBs) are obtained from Current Procedural Terminology (CPT), copyright 2015 by the American Medical Association (AMA). Refer to the CDC website for the most recent guidance on antibody testing. Aetna generally does not reimburse doctors and dentists for Personal Protection Equipment. Lab-based PCR home collection kits are not covered at this time by the OTC kit mandate. Home test kits may be eligible for reimbursement through OptumRx if the test was purchased after January 15, 2022. Links to various non-Aetna sites are provided for your convenience only. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. Providers will bill Medicare. Treating providers are solely responsible for medical advice and treatment of members. 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. If the plan provides in and out of network coverage, then the cost-sharing waiver applies to testing performed or ordered by in-network or out-of-network providers. So if someone calls you to sell you an insurance policy or change your current policy even if the person says they represent Aetna call us first at the number on your ID card or 1-800-872-3862 (TTY: 711). A BinaxNow test shows a negative result for COVID-19. Last update: February 1, 2023, 4:30 p.m. CT. Just enter your mobile number and well text you a link to download the Aetna Health app from the App Store or on Google Play. 3Rates above are not applicable to Aetna Better Health Plans. In addition, health insurers now provide or reimburse the cost of up to eight home tests per month for most . The responsibility for the content of Aetna Precertification Code Search Tool is with Aetna and no endorsement by the AMA is intended or should be implied. Tests must be purchased on or after January 15, 2022. The term precertification here means the utilization review process to determine whether the requested service, procedure, prescription drug or medical device meets the company's clinical criteria for coverage. Aetna has reached these conclusions based upon a review of currently available clinical information (including clinical outcome studies in the peer-reviewed published medical literature, regulatory status of the technology, evidence-based guidelines of public health and health research agencies, evidence-based guidelines and positions of leading national health professional organizations, views of physicians practicing in relevant clinical areas, and other relevant factors). Who the tests are for (self or dependent), Your pharmacy plan should be able to provide that information. Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. Box 981106, El Paso, TX 79998-1106. This applies whether you purchased your health . CVS Pharmacy, HealthHUB and MinuteClinic will continue to serve customers and patients. 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. 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. That's beginning to change, however. For members with CVS Caremark pharmacy benefits or whose employer covers these tests under medical benefits: Members with CVS Caremark & members whose plan sponsor is covering under medical. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. 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. LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). The new states are Alabama, Arkansas, Colorado, Delaware, Iowa, Mississippi, Montana, North Dakota, Oregon and West Virginia. This member cost-sharing waiver applies to all Commercial, Medicare and Medicaid lines of business. The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. Examples of such documentation could include the UPC code for the OTC COVID-19 test and/or a receipt from the seller of the test, documenting the date of purchase and the price of the OTC COVID-19 test. The Biden administration is selling a key part of its pandemic strategy as free at-home Covid-19 tests for all. We cover, without member cost sharing, a same day office, emergency room, or other provider visit at which a COVID-19 test is ordered or administered. By submitting a claim to Aetna for COVID-19 testing, providers acknowledge that the above amounts will be accepted as payment in full for each COVID-19 test performed, and that they will not seek additional reimbursement from members. Through this effort we are hoping to provide access in areas of the country that need additional testing and are selecting CVS Pharmacy locations with this criteria in mind. PPE, like other disposable infection control supplies, is part of the cost of the underlying procedure. 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. No, Aetna will pay the amount of the cost-sharing the member would have ordinarily paid so the provider would receive the same total payment. Up to eight tests per 30-day period are covered. Building on the companys comprehensive efforts to help slow the spread of the virus, we can bring safe and effective testingoptions closer to home and help increase access to testing options for even more individuals. The Biden Administration announced on December 2, 2021 (followed by detailed guidance released on January 10, 2022) that private insurers would be required to also begin covering the cost of rapid . This information is available on the HRSA website. Go to the American Medical Association Web site. OTC COVID-19 tests can be purchased at pharmacies, retail locations or online. . This pilot provided the company with a number of key learnings, which helped inform the companys ability to improve on and maximize drive-through testing for consumers. For more information and future updates, visit the CMS website and its newsroom. You can find a partial list of participating pharmacies at Medicare.gov. 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. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Please log in to your secure account to get what you need. 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. Please be sure to add a 1 before your mobile number, ex: 19876543210. If the plan provides in and out of network coverage, then the cost-sharing waiver applies to testing performed or ordered by in-network or out-of-network providers. For the time being, you'll have to submit a claim to get reimbursed after you buy tests. The following are some of the national labs approved to do COVID-19 testing(other commercial labs are also approved): There are other participating commercial labs, hospitals and urgent care centers authorized to provide COVID-19 lab testing. 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. Yes, Aetna will cover tests approved, cleared or authorized by the U.S. Food and Drug Administration. This includes those enrolled in a Medicare Advantage plan. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. If you have health coverage through Cigna, you will need to print and fill out this at-home COVID-19 test reimbursement form. Even if the person gives you a different number, do not call it. Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. If you bought or ordered an at-home COVID-19 test on or after January 15, 2022, you may be able to get reimbursed for the cost. Aetna Medicare members can obtain OTC COVID-19 tests from participating providers and pharmacies, but will not be reimbursed for self-purchased tests. Who the tests are for (self or dependent), Your pharmacy plan should be able to provide that information. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. COVID-19 home test kit returns will not be accepted. (Offer to transfer member to their PBMs customer service team.). Aetna: Aetna POSII, Aetna HDHP and Aetna POSII (ACA) Under the Aetna Plans COVID testing is currently covered at 100% for provider visits in and out of network. 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. Under President Trump's leadership, the Centers for Medicare & Medicaid Services (CMS) today announced new actions to pay for expedited coronavirus disease 2019 (COVID-19) test results. INDICAID COVID-19 Rapid Antigen Test, 1 Pack, 2 Tests Total, 4 Easy Steps & Results in 20 Minutes - Covid OTC Nasal Swab Test - HSA/FSA Reimbursement Eligible INDICAID $16.50 $ 16 . 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. 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. Effective April 4, 2022, Medicare will cover up to eight (8) at-home COVID-19 tests per person every 30 days or four (4) two-test, rapid antigen at-home tests every 30 days without a prescription. As the insurer Aetna says . If in-patient treatment was required for a member with a positive COVID-19 diagnosis prior to this announcement it will be processed in accordance with this new policy. 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. 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. CMS established these requirements to support faster high throughput COVID-19 diagnostic testing and to ensure all patients (not just Medicare patients) benefit from faster testing. 2Disclaimer: Regulations regarding testing for Aetna Medicaid members vary by state and, in some cases, may change in light of the current situation. For more information on what tests are eligible for reimbursement, visit OptumRx's website. Americans with private insurance will be able to ask for reimbursement for rapid COVID-19 tests beginning Saturday but any tests purchased before January 15 will not qualify. Providers are encouraged to call their provider services representative for additional information. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. You are now being directed to the CVS Health site. Once completed you can sign your fillable form or send for signing. This coverage continues until the COVID-19 . Learn whats covered and the steps to get reimbursed. 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. 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). In a . Based on new federal guidelines, Aetnas private, employer-sponsored and student health commercial insurance plans will cover up to eight over the counter (OTC) at-home COVID-19 tests per 30-day period for each person covered under your plan. Aetna has reached these conclusions based upon a review of currently available clinical information (including clinical outcome studies in the peer-reviewed published medical literature, regulatory status of the technology, evidence-based guidelines of public health and health research agencies, evidence-based guidelines and positions of leading national health professional organizations, views of physicians practicing in relevant clinical areas, and other relevant factors). Some insurance companies, like Kaiser Permanente, Aetna and Blue Shield of California, are asking policyholders to request a reimbursement after purchasing a COVID-19 test by filling out a claim form. Aetna is reaching out to the commercial labs about their ability to provide the COVID-19 testing. Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept". This waiver may remain in place in states where mandated. Aetna will accept claims for reimbursement for tests purchased at out-of-network retailers. Tests used for employment, school or recreational purposes are not eligible for reimbursement unless required by state law. Treating providers are solely responsible for medical advice and treatment of members. On March 16, the CMS released details about how COVID-19 testing would be reimbursed to health care providers administering the tests. 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. Patients will need to pre-register, provide their insurance information as appropriate and verify their eligibility for testing. For more information about the virus, please visit the CDC and/or WHO websites dedicated to this issue. Please be sure to add a 1 before your mobile number, ex: 19876543210. In addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members. Sign in or register at Caremark.com (You must be a CVS Caremark member) On average, the test results are typically available within 1-2 days, but may take longer due to local surges in COVID-19. Aetna Medicare plans do not reimburse for OTC COVID-19 tests. CVS Pharmacy, HealthHUB and MinuteClinic will continue to serve customers and patients. In effort to expand testing capabilities, U.S. Department of Health & Human Services (DHS) authorized pharmacists to order and administer COVID-19 tests, including serology tests, that the FDA has authorized. You are not eligible if you have Medicare, Medicare Supplement, Medicaid, or voluntary insurance. Members should discuss any matters related to their coverage or condition with their treating provider. (For example, BinaxNOW offers a package with two tests included that would count as two individual tests). Through this effort we are hoping to provide access in areas of the country that need additional testing and are selecting CVS Pharmacy locations with this criteria in mind. U0002. You can only get reimbursed for tests purchased on January 15, 2022 or later. Unlisted, unspecified and nonspecific codes should be avoided. Access trusted resources about COVID-19, including vaccine updates. You can submit up to 8 tests per covered member per month. You can continue to use your HSA even if you lose your job. CPT is a registered trademark of the American Medical Association. . If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. All forms are printable and downloadable. Providers will bill Medicare. Claim Coding, Submissions and Reimbursement. They may also order up to two sets of four at-home tests per household by visiting COVIDtests.gov. If your pharmacy benefits are not with Aetna, contact your pharmacy benefits administrator for instructions. Any test ordered by your physician is covered by your insurance plan. CVS Health is actively monitoring the global COVID-19 pandemic including guidance from trusted sources of clinical information such as the Centers for Disease Control (CDC) and World Health Organization (WHO). When you submit your claim, youll need to include: Youll also be asked to attest that the OTC kit is for personal use only, and not for employment, school, recreational or travel purposes. Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. Aetna is complying with the CMS coding guidelines for COVID-19 lab testing. The Dental Clinical Policy Bulletins (DCPBs) describe Aetna's current determinations of whether certain services or supplies are medically necessary, based upon a review of available clinical information. Providers can seek reimbursement for uninsured patients through the Health Resources & Services Administration (HRSA) for COVID-19 testing, treatment and vaccine administration. You, your employees and agents are authorized to use CPT only as contained in Aetna Precertification Code Search Tool solely for your own personal use in directly participating in health care programs administered by Aetna, Inc. You acknowledge that AMA holds all copyright, trademark and other rights in CPT. 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. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. Complete this form for each covered member. Tests must be used to diagnose a potential COVID-19 infection. Aetna will cover treatment of COVID-19 for our Medicare Advantage members. Coverage is available for members eligible with Medicare Part B FFS or Medicare Advantage Benefits. Tests must be FDA-authorized. $35.92. Members should take their red, white and blue Medicare card when they pick up their tests. 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. 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. Laboratories that complete a majority of COVID-19 diagnostic tests run on high throughput technology within two days will be paid $100 per test by Medicare, while laboratories that take longer will receive $75 per test. The site said more information on how members can submit claims will soon be available. Visit the secure website, available through www.aetna.com, for more information. Health benefits and health insurance plans contain exclusions and limitations. Please refer to the FDA and CDC websites for the most up-to-date information. Links to various non-Aetna sites are provided for your convenience only. 7/31/2021. Treating providers are solely responsible for dental advice and treatment of members. You wont be able to get reimbursed for tests* that: * May be subject to state-specific COVID-19 coverage mandates. Blue Shield of California, Care First, Cigna, CVS Group/Aetna, and Kaiser Permanente) are currently relying only on reimbursement . In addition, Aetna is waiving member cost-sharing for diagnostic testing related to COVID-19. CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to the implied warranties of merchantability and fitness for a particular purpose. A list of approved tests is available from the U.S. Food & Drug Administration. This policy for diagnostic and antibody testing applies to Commercial, Medicare and Medicaid plans.2. If your reimbursement request is approved, a check will be mailed to you. The policy . Medicare covers the vaccine for anyone who has Medicare due to their age, a disability, End-Stage Renal Disease (ESRD), or ALS (also called . No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Aetna is in the process of developing a direct-to-consumer shipping option. Aetna participating providers should not bill members for Enhanced Infection Control and/or PPE. Based on new federal guidelines, Aetnas private, employer-sponsored and student health commercial insurance plans will cover up to eight over the counter (OTC) at-home COVID-19 tests per 30-day period for each person covered under your plan. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Consumers will have the option to either order tests online for free or purchase a test in-store and submit receipts to their insurance company for reimbursement. Patient samples collected at our COVID-19 drive-thru testing sites are sent offsite to independent, third-party labs who are responsible for processing and delivering the results, which we then communicate to patients. 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.
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