Get the latest updates on every aspect of the pandemic. 4. Those who have already purchased . Aetna will cover, without cost share, diagnostic (molecular PCR or antigen) tests to determine the need for member treatment.1Aetnas health plans generally do not cover a test performed at the direction of a members employer in order to obtain or maintain employment or to perform the members normal work functions or for return to school or recreational activities, 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. 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. 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. Laboratories using the test developed by the Center for Disease Control and Prevention (CDC) would be reimbursed $36 per test. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. No fee schedules, basic unit, relative values or related listings are included in CPT. If you have health coverage through Cigna, you will need to print and fill out this at-home COVID-19 test reimbursement form. You can submit up to 8 tests per covered member per month. Below is information about policies and procedures that CVS Health has implemented that focus on the health and safety of our colleagues, customers, members and patients. Postal Service will ship the tests directly to your door free of charge. You can also use it to pay for medical, dental and vision bills, including telehealth and COVID-19 treatment. 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. OTC COVID-19 tests can be purchased at pharmacies, retail locations or online. In addition, Aetna is waiving member cost-sharing for diagnostic testing related to COVID-19. Who the tests are for (self or dependent), Your pharmacy plan should be able to provide that information. Members should discuss any matters related to their coverage or condition with their treating provider. 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. . COVID-19 testing, vaccines, hospitalizations and related expenses will return to the standard coverage for in-network and out of network services. This includes the testing only not necessarily the Physician visit. This requirement will continue as long as the COVID public health emergency lasts. Sign in or register at Caremark.com (You must be a CVS Caremark member) Although the federal government is not providing free tests at this time, it has taken steps to ensure that people are able to get free tests through their health insurance - Medicare included. Instead, an appropriate specimen should be collected at the health care facility where the patient was seen and the test was ordered or at other non-lab facilities. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. Even if the person gives you a different number, do not call it. Please be sure to add a 1 before your mobile number, ex: 19876543210. Since then, CVS Health has continued to expand access to COVID-19 testing, establishing testing sites at more than 4,800 CVS Pharmacy locations across the country, including nearly 1,000 of which provide rapid-result testing. Applicable FARS/DFARS apply. Providers will bill Medicare. It is only a partial, general description of plan or program benefits and does not constitute a contract. You are now being directed to CVS caremark site. 1Aetna will follow all federal and state mandates for insured plans, as required. 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. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. 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. Our ability to coordinate the availability of COVID-19 testing bolsters states efforts to manage the spread of the virus. Up to eight tests per 30-day period are covered. Applicable FARS/DFARS apply. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Refer to the U.S. Food & Drug Administration on tests that are eligible for coverage. 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. Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept". Please log in to your secure account to get what you need. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. 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 the event a claim has already been processed prior to this policy going into effect, members should contact Customer Service so the claim can be reprocessed accordingly. In a . 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)*. The site said more information on how members can submit claims will soon be available. If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. Testing will not be available at all CVS Pharmacy locations. Important: Use your Aetna ID that starts with a "W.". Get PCR tests and antigen tests through a lab at no cost when a doctor or other health care professional orders it for you. The ABA Medical Necessity Guidedoes not constitute medical advice. Patients will need to pre-register, provide their insurance information as appropriate and verify their eligibility for testing. 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. License to use CPT for any use not authorized herein must be obtained through the American Medical Association, CPT Intellectual Property Services, 515 N. State Street, Chicago, Illinois 60610. 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. Members should discuss any Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider. While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. 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. You can only get reimbursed for tests purchased on January 15, 2022 or later. reimbursement scheme relies on people being able to find rapid COVID tests to buy either online or at their local pharmacy. PPE, like other disposable infection control supplies, is part of the cost of the underlying procedure. You can find a partial list of participating pharmacies at Medicare.gov. 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. This mandate is in effect until the end of the federal public health emergency. Members should take their red, white and blue Medicare card when they pick up tests. 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. Refer to the CDC website for the most recent guidance on antibody testing. Our ability to coordinate the availability of COVID-19 testing bolsters states efforts to manage the spread of the virus. All Rights Reserved. The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. During the COVID-19 PHE, get one lab-performed test without a health care professional's order, at no cost. This includes those enrolled in a Medicare Advantage plan. Aetna is working to protect you from COVID-19 scams. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. For people . If you do not intend to leave our site, close this message. This allows us to continue to help slow the spread of the virus. 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. Claims for reimbursement for at home COVID-19 tests may be submitted online or via mail using the printable form. 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. Unlisted, unspecified and nonspecific codes should be avoided. Note: Each test is counted separately even if multiple tests are sold in a single package. While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. Aetna will cover treatment of COVID-19 for our Medicare Advantage members. . Aetna updated its website Friday with new frequently asked questions about the new requirement. CMS previously took action in April 2020 by increasing the Medicare payment to laboratories for high throughput COVID-19 diagnostic tests from approximately $51 to $100 per test. The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. You can administer the test and read the results yourself, without the help of a health care provider, Have to be sent to a lab (for example, Pixel, MyLab Box), Require a health care professional (doctor or nurse) to administer or read the test (for example, PCR or rapid tests). The tests, part of the administration's purchase of 500 million tests last . Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Please note that copays, deductibles and coinsurance will apply according to the members benefit plan. Boxes of iHealth COVID-19 rapid test kits. Coverage is in effect, per the mandate, until the end of the federal public health emergency. To help improve access to these tests, the Biden-Harris Administration is expanding access to free at-home kits through the federal government. This member cost-sharing waiver applies to all Commercial, Medicare and Medicaid lines of business. Yes, patients must register in advance at CVS.com to schedule an appointment. 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. You can continue to use your HSA even if you lose your job. Please report any scams by calling 1-800-447-8477 or online at https://tips.oig.hhs.gov/. COVID-19 At-Home Test Reimbursement. Aetna defines a service as "never effective" when it is not recognized according to professional standards of safety and effectiveness in the United States for diagnosis, care or treatment. The member's benefit plan determines coverage. It doesnt need a doctors order. Since January 2022, health insurance plans have been required to cover the cost of at-home rapid tests for COVID-19. Reimbursement for using the CDC 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Panel. 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. 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. $35.92. Detect Covid-19 test. This policy for diagnostic and antibody testing applies to Commercial, Medicare and Medicaid plans.2. Members must get them from participating pharmacies and health care providers. CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. 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. Medicare covers the vaccine for anyone who has Medicare due to their age, a disability, End-Stage Renal Disease (ESRD), or ALS (also called . Your benefits plan determines coverage. When billing, you must use the most appropriate code as of the effective date of the submission. If you dont see your patient coverage question here, let us know. 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. 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". The cost-sharing waiver applies to testing performed or ordered by in-network or out-of-network providers. The U.S. Patrick T. Fallon/AFP/Getty Images via Bloomberg. Lab-based PCR home collection kits are not covered at this time by the OTC kit mandate. However, you will likely be asked to scan a copy of . U0002. 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. Treating providers are solely responsible for medical advice and treatment of members. The member's benefit plan determines coverage. 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. Each site operated seven days a week, providing results to patients on-site, through the end of June. You can only get reimbursed for tests purchased on January 15, 2022 or later. 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. Treating providers are solely responsible for medical advice and treatment of members. Go to the American Medical Association Web site. Do not respond if you get a call, text or email about "free" coronavirus testing. Tests must be approved, cleared or authorized by the. The tests come at no extra cost. 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. Providers will bill Medicare. You can use this money to pay for HSA eligible products. 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. At this time, covered tests are not subject to frequency limitations. 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. Access trusted resources about COVID-19, including vaccine updates. Once completed you can sign your fillable form or send for signing. Americans with health insurance can get up to eight at-home coronavirus tests for free thanks to a new requirement. 1-800-557-6059 | TTY 711, 24/7. For more information on test site locations in a specific state, please visit CVS.com. The specimen should be sent to these laboratories using standard procedures. Aetna will accept claims for reimbursement for tests purchased at out-of-network retailers. Yes. Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. Any COVID-19 test ordered by your physician is covered by your insurance plan. CPT is a registered trademark of the American Medical Association. 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. This page provides MassHealth Coronavirus Disease (COVID-19) guidance and information for all MassHealth providers. Members should take their red, white and blue Medicare card when they pick up their tests. Aetna will cover treatment of COVID-19 for our Medicare Advantage members. Testing, coding and reimbursement protocols and guidelines are established based on guidance from the Centers for Medicare & Medicaid Services (CMS), the Centers for Disease Control and Prevention (CDC), state and federal governments and other . Aetna Better Health plan pricing may be determined by each individual health plan in accordance with its state contracts. Do you want to continue? Subject to applicable law, Aetna may deny tests that do not meet medical necessity criteria. 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. Due to high demand for OTC at-home COVID-19 tests, supplies may be limited in some areas. CPT only copyright 2015 American Medical Association. Others have four tiers, three tiers or two tiers. Consumers who are fortunate enough to get their hands on over-the-counter, rapid COVID-19 tests will soon be reimbursed by their insurers for the cost of such devices under new . This policy for diagnostic and antibody testing applies to Commercial, Medicare and Medicaid plans.2. 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. This waiver may remain in place in states where mandated. Links to various non-Aetna sites are provided for your convenience only. Please note: Your receipt must be dated January 15, 2022 or later to be eligible for reimbursement. In April, CVS Health joined forces with the U. S. Department of Health and Human Services and state governments in Connecticut, Georgia, Massachusetts, Michigan and Rhode Island to help increase access to rapid COVID-19 testing at large-scale sites in publicly accessible areas. 8/31/2021. Aetna Medicare members can obtain OTC COVID-19 tests from participating providers and pharmacies, but will not be reimbursed for self-purchased tests. CPT is a registered trademark of the American Medical Association. Yes. The American Medical Association (AMA) does not directly or indirectly practice medicine or dispense medical services. 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. Complete this form for each covered member. 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. 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. 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. 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 over-the-counter COVID-19 tests will be covered at a reimbursement rate of up to $12 per test, with a quantity limit of eight tests per covered individual every 30 days for test kits obtained . CPT only Copyright 2022 American Medical Association. 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. Tests used for employment, school or recreational purposes are not eligible for reimbursement unless required by state law. 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. 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 physicians orders1. Call 1-800-Medicare (1-800-633-4227) with any questions about this initiative. As omicron has soared, the tests' availability seems to have plummeted. 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. 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. 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 . Please refer to the FDA and CDC websites for the most up-to-date information. 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. National labs will not collect specimens for COVID-19 testing. 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. This coverage continues until the COVID-19 . 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 physicians orders1.