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. CVS Pharmacy, HealthHUB and MinuteClinic will continue to serve customers and patients. 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 information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. Those who have already purchased . 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. Tests must be FDA-authorized. The information you will be accessing is provided by another organization or vendor. You are not eligible if you have Medicare, Medicare Supplement, Medicaid, or voluntary insurance. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. In addition, health insurers now provide or reimburse the cost of up to eight home tests per month for most . Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. CPT only Copyright 2022 American Medical Association. Go to the American Medical Association Web site. Now, however, anyone in the U.S. can order a total of four free tests per household via COVIDtests.gov. At-home COVID-19 tests are excluded from all coupon discounts and promotions, including CarePass and ExtraBucks Rewards . 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. The Biden administration will launch a website where Americans can order free coronavirus tests on Jan. 19.. Unlisted, unspecified and nonspecific codes should be avoided. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements. Yes. Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. All Rights Reserved. For the time being, you'll have to submit a claim to get reimbursed after you buy tests. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. This search will use the five-tier subtype. Download the form below and mail to: Aetna, P.O. The new states are Alabama, Arkansas, Colorado, Delaware, Iowa, Mississippi, Montana, North Dakota, Oregon and West Virginia. The AMA is a third party beneficiary to this Agreement. A BinaxNow test shows a negative result for COVID-19. CVS Pharmacy, HealthHUB and MinuteClinic will continue to serve customers and patients. Tests must be approved, cleared or authorized by the. It is only a partial, general description of plan or program benefits and does not constitute a contract. 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. Some pharmacies may not be able to process claims for OTC COVID-19 tests at the pharmacy counter. . . 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. Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. Our ability to coordinate the availability of COVID-19 testing bolsters states efforts to manage the spread of the virus. Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. You can only get reimbursed for tests purchased on January 15, 2022 or later. Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search. 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. In addition, Aetna is waiving member cost-sharing for diagnostic testing related to COVID-19. (Offer to transfer member to their PBMs customer service team.). Under the federal governments current guidelines, tests are eligible if: Eligible tests include single-use, cartridge-based tests (for example, Flowflex, BinaxNow or Ongo). Recently, the United States government made available four free at-home COVID-19 tests to each home address upon request. At this time, covered tests are not subject to frequency limitations. Pharmacists, in partnership with other health care providers, are well positioned to aid COVID-19 testing expansion. Blue Shield of California, Care First, Cigna, CVS Group/Aetna, and Kaiser Permanente) are currently relying only on reimbursement . For CVS Health testing initiatives, see section titled, COVID-19 drive-thru testing at CVS Pharmacy locations. The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. 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. Patients will need to pre-register, provide their insurance information as appropriate and verify their eligibility for testing. All Rights Reserved. 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. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. 3Rates above are not applicable to Aetna Better Health Plans. Aetna will cover, without cost share, serological (antibody) tests that are ordered by a physician or authorized health care professional and are medically necessary. Yes, Aetna will cover tests approved, cleared or authorized by the U.S. Food and Drug Administration. Providers are encouraged to call their provider services representative for additional information. The reality may be far different, adding hurdles for . This information is neither an offer of coverage nor medical advice. Medicare covers the updated COVID-19 vaccine at no cost to you. 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. Sign in or register at Caremark.com (You must be a CVS Caremark member) They should check to see which ones are participating. No. 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 . Claims for reimbursement for at home COVID-19 tests may be submitted online or via mail using the printable form. This does not apply to Medicare. 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. Subject to applicable law, Aetna may deny tests that do not meet medical necessity criteria. 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. Members should discuss any matters related to their coverage or condition with their treating provider. CVS Health currently has more than 4,800 locations across the country offering COVID-19 testing. 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: While the Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. Lab-based PCR home collection kits are not covered at this time by the OTC kit mandate. 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. Please note that copays, deductibles and coinsurance will apply according to the members benefit plan. These guidelines do not apply to Medicare. They should check to see which ones are participating. On average this form takes 13 minutes to complete. When submitting COVID-19-related claims, follow the coding guidelines and guidance outlined below and review the CDC guideline for ICD-10-CM . 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. 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. . 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)*. (Offer to transfer member to their PBMs customer service team.). 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. 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. 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. 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). 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. When billing, you must use the most appropriate code as of the effective date of the submission. Note: Each test is counted separately even if multiple tests are sold in a single package. Please note: Your receipt must be dated January 15, 2022 or later to be eligible for reimbursement. The requirement also applies to self-insured plans. MINNEAPOLIS On Tuesday, White House Press Secretary Jen Psaki tweeted that the Biden administration will make sure every insured American can get reimbursed for their at-home COVID tests. 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. Learn more about what's covered and what you need to do to get reimbursed, and get answers to other frequently asked questions about at-home COVID-19 self-test coverage. This information is available on the HRSA website. Send it to the address shown on the form. 2Disclaimer: Regulations regarding testing for Aetna Medicaid members vary by state and, in some cases, may change in light of the current situation. Up to eight tests per 30-day period are covered. 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. This member cost-sharing waiver applies to all Commercial, Medicare and Medicaid lines of business. ", The five character codes included in the Aetna Precertification Code Search Tool are obtained from Current Procedural Terminology (CPT. 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. 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. In case of a conflict between your plan documents and this information, the plan documents will govern. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. 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). Home Test Kit Reimbursement. Rates may vary for Commercial Plans based on factors such as billed charges or contractual terms. Tests used for employment, school or recreational purposes are not eligible for reimbursement unless required by state law. Some pharmacies may not be able to process claims for OTC COVID-19 tests at the pharmacy counter. The following rates are used for COVID-19 testing for commercial and Medicare plans, unless noted otherwise: Diagnostic testing/handling rates - Medicare. Others have four tiers, three tiers or two tiers. 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. 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. 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. Health benefits and health insurance plans contain exclusions and limitations. Self-insured plan sponsors offered this waiver at their discretion. All Rights Reserved. Aetna is working to protect you from COVID-19 scams. Your employer or health plan will have the best information on how to buy OTC COVID-19 tests that will be covered. Links to various non-Aetna sites are provided for your convenience only. Last update: February 1, 2023, 4:30 p.m. CT. Members should take their red, white and blue Medicare card when they pick up their tests. Coverage is in effect, per the mandate, until the end of the federal public health emergency. For language services, please call the number on your member ID card and request an operator. 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). Get the latest updates on every aspect of the pandemic. They may also order up to two sets of four at-home tests per household by visitingCOVIDtests.gov. If you do not intend to leave our site, close this message. 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. 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. Reimbursement for using the CDC 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Panel. Providers can seek reimbursement for uninsured patients through the Health Resources & Services Administration (HRSA) for COVID-19 testing, treatment and vaccine administration. 4. In case of a conflict between your plan documents and this information, the plan documents will govern. 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. Refer to the CDC website for the most recent guidance on antibody testing. Medical Reimbursement: COVID Over-the-Counter Test Form (PDF) . Your pharmacy plan should be able to provide that information. The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. This also applies to Medicare and Medicaid plan coverage. The tests come at no extra cost. They may also order up to two sets of four at-home tests per household by visiting COVIDtests.gov. 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. reimbursement scheme relies on people being able to find rapid COVID tests to buy either online or at their local pharmacy. Providers will bill Medicare. Please note also that the ABA Medical Necessity Guidemay be updated and are, therefore, subject to change. 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. Since January 2022, health insurance plans have been required to cover the cost of at-home rapid tests for COVID-19. CPT only copyright 2015 American Medical Association. 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. HCPCS code. 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. The COVID-19 At-Home Test Reimbursement form is 1 page long and contains: While Clinical Policy Bulletins (CPBs) define Aetna's clinical policy, medical necessity determinations in connection with coverage decisions are made on a case by case basis. This includes those enrolled in a Medicare Advantage plan. 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. Go to the American Medical Association Web site. This Agreement will terminate upon notice if you violate its terms. 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. Please log in to your secure account to get what you need. Members should take their red, white and blue Medicare card when they pick up their tests. U0002. The Biden administration is selling a key part of its pandemic strategy as free at-home Covid-19 tests for all. Aetna generally does not reimburse doctors and dentists for Personal Protection Equipment. The omicron surge may be receding in Michigan, but more than 13,000 in the state are still testing . 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. 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.
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