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. This policy for diagnostic and antibody testing applies to Commercial, Medicare and Medicaid plans.2. If you do not intend to leave our site, close this message. This coverage continues until the COVID-19 . For language services, please call the number on your member ID card and request an operator. This mandate is in effect until the end of the federal public health emergency. The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. If you don't see your testing and treatment questions here, let us know. It is only a partial, general description of plan or program benefits and does not constitute a contract. If you suspect price gouging or a scam, contact your state . The new states are Alabama, Arkansas, Colorado, Delaware, Iowa, Mississippi, Montana, North Dakota, Oregon and West Virginia. This policy for diagnostic and antibody testing applies to Commercial, Medicare and Medicaid plans.2. Aetna is reaching out to the commercial labs about their ability to provide the COVID-19 testing. The information you will be accessing is provided by another organization or vendor. 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. 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. This member cost-sharing waiver applies to all Commercial, Medicare and Medicaid lines of business. Last update: February 1, 2023, 4:30 p.m. CT. 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. 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. 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). This search will use the five-tier subtype. 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. Visit the secure website, available through www.aetna.com, for more information. Testing will not be available at all CVS Pharmacy locations. All claims received for Aetna-insured members going forward will be processed based on this new policy. Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. Pharmacists, in partnership with other health care providers, are well positioned to aid COVID-19 testing expansion. All Rights Reserved. The updated vaccine targets the original COVID-19 viral strain and 2 Omicron variants (BA.4/BA.5). To make sure I didn't have COVID, I purchased a COVID test kit from Walgreens . 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. Your pharmacy plan should be able to provide that information. If you have private, employer-sponsored or student health commercial insurance youre eligible to get reimbursed for over-the-counter at-home COVID kits. CPT only copyright 2015 American Medical Association. 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. 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). Each main plan type has more than one subtype. CPT only Copyright 2022 American Medical Association. 3Rates above are not applicable to Aetna Better Health Plans. 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 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. CVS Pharmacy, HealthHUB and MinuteClinic will continue to serve customers and patients. 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. Since Dental Clinical Policy Bulletins (DCPBs) 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. Patients will need to pre-register, provide their insurance information as appropriate and verify their eligibility for testing. 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. Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept". You are now being directed to CVS caremark site. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. 7/31/2021. 2Disclaimer: Regulations regarding testing for Aetna Medicaid members vary by state and, in some cases, may change in light of the current situation. CVS Health currently has more than 4,800 locations across the country offering COVID-19 testing. This excerpt is provided for use in connection with the review of a claim for benefits and may not be reproduced or used for any other purpose. The health insurance company Aetna has a guide on . Medicare covers the updated COVID-19 vaccine at no cost to you. Patrick T. Fallon/AFP/Getty Images via Bloomberg. Aetna Medicaid Illinois is here for you during the coronavirus (COVID-19) pandemic, no matter what. In addition, health insurers now provide or reimburse the cost of up to eight home tests per month for most . In addition, Aetna is waiving member cost-sharing for diagnostic testing related to COVID-19. 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). Self-insured plan sponsors offered this waiver at their discretion. 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. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. 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. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. 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. Access trusted resources about COVID-19, including vaccine updates. It is only a partial, general description of plan or program benefits and does not constitute a contract. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Your pharmacy plan should be able to provide that information. 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. 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. Each main plan type has more than one subtype. 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. Those using a non-CDC test will be reimbursed $51 . Get the latest updates on every aspect of the pandemic. Aetna members can now receive reimbursement for test kits purchased on or after Jan. 15, 2022. Pharmacists, in partnership with other health care providers, are well positioned to aid COVID-19 testing expansion. Members should discuss any matters related to their coverage or condition with their treating provider. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. Tests must be used to diagnose a potential COVID-19 infection. Lab-based PCR home collection kits are not covered at this time by the OTC kit mandate. 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 . For language services, please call the number on your member ID card and request an operator. For members with Aetna pharmacy benefits, you can submit a claim for reimbursement through your Aetna member website. 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. (For example, BinaxNOW offers a package with two tests included that would count as two individual tests). 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. 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 March, CVS Health opened a pilot drive-through COVID-19 test site in a parking lot at a CVS Pharmacy store in Shrewsbury, MA. 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. . Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. 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 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. The tests were shipped through the U.S. Providers will bill Medicare. Members should take their red, white and blue Medicare card when they pick up tests. 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. Rates may vary for Commercial Plans based on factors such as billed charges or contractual terms. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. 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. Who the tests are for (self or dependent), Your pharmacy plan should be able to provide that information. Some subtypes have five tiers of coverage. All services deemed "never effective" are excluded from coverage. Tests must be FDA-authorized. 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. Once they have registered, the patient will be provided with an appointment window for up to seven days in advance. The tests come at no extra cost. 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). All Rights Reserved. TTY users can call 1-877-486-2048. 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. Members will need to submit a claim for reimbursement through the Aetna website and will receive a check once the claim is approved. Laboratories using the test developed by the Center for Disease Control and Prevention (CDC) would be reimbursed $36 per test. Aetna generally does not reimburse doctors and dentists for Personal Protection Equipment. Aetna is working to protect you from COVID-19 scams. Go to the pharmacy website or call the relevant pharmacy to confirm participating locations and get details on how to order. Copyright 2015 by the American Society of Addiction Medicine. COVID-19 testing, vaccines, hospitalizations and related expenses will return to the standard coverage for in-network and out of network services. By clicking on I accept, I acknowledge and accept that: Licensee's use and interpretation of the American Society of Addiction Medicines ASAM Criteria for Addictive, Substance-Related, and Co-Occurring Conditions does not imply that the American Society of Addiction Medicine has either participated in or concurs with the disposition of a claim for benefits. If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. COVID-19 At-Home Test Reimbursement. Reimbursement for using the CDC 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Panel. 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. Medicare covers one of these PCR kits per year at $0. 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. 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 waiver may remain in place in states where mandated. $35.92. Refer to the U.S. Food & Drug Administration on tests that are eligible for coverage. Lab-based PCR home collection kits are not covered at this time by the OTC kit mandate. 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). Learn whats covered and the steps to get reimbursed. You can only get reimbursed for tests purchased on January 15, 2022 or later. (Offer to transfer member to their PBMs customer service team.). The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. Do you want to continue? No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. This mandate is in effect until the end of the federal public health emergency. *The content below is not intended to be a substitute for professional medical advice, diagnosis or treatment. Tests must be approved, cleared or authorized by the. For more information on what tests are eligible for reimbursement, visit OptumRx's website. The cost-sharing waiver applies to testing performed or ordered by in-network or out-of-network providers. Get a COVID-19 vaccine as soon as you can. Blue Shield of California, Care First, Cigna, CVS Group/Aetna, and Kaiser Permanente) are currently relying only on reimbursement . You can use this money to pay for HSA eligible products. Tests must be approved, cleared or authorized by the. Claim Coding, Submissions and Reimbursement. If you dont see your patient coverage question here, let us know. 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. Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search. 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. They may also order up to two sets of four at-home tests per household by visiting COVIDtests.gov. Please refer to the FDA and CDC websites for the most up-to-date information. This does not apply to Medicare. On average this form takes 13 minutes to complete. 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. 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 . Treating providers are solely responsible for dental advice and treatment of members. . Treating providers are solely responsible for medical advice and treatment of members. Using FSA or HSA Funds. 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. 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. Up to eight tests per 30-day period are covered. Detect Covid-19 test. Aetna's 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). Members should take their red, white and blue Medicare card when they pick up their tests. GC-1664-3 (12-22) Aetna Medicare Page 1 of 3 R-POD C Member information (print clearly) Medicare Medical Claim Reimbursement Form Aetna member ID: Date of birth (MM/DD/YYYY): Male Female (If you prefer not to disclose, leave blank) Last name: First name: Middle initial: Street address: City: COVID-19 Testing, Treatment, Coding & Reimbursement. Recently, the United States government made available four free at-home COVID-19 tests to each home address upon request. The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. 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 tests come at no extra cost. This includes those enrolled in a Medicare Advantage plan. 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. You are now being directed to the CVS Health site. Coverage is in effect, per the mandate, until the end of the federal public health emergency. The member's benefit plan determines coverage. Save your COVID-19 test purchase receipts. 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. A BinaxNow test shows a negative result for COVID-19. Please refer to the FDA and CDC websites for the most up-to-date information. Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. 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. Get started with your reimbursement request. No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM. 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 example, Binax offers a package with two tests that would count as two individual tests. 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 . 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. Aetna will cover, without cost share, serological (antibody) tests that are ordered by a physician or authorized health care professional and are medically necessary. 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 . 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. 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. 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. 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. Note: Each test is counted separately even if multiple tests are sold in a single package. These actions will be implemented under the amended Administrative Ruling (CMS-2020-1-R2) and coding instructions for the $25 add-on payment (HCPCS code U0005). This information is available on the HRSA website. Note: Each test is counted separately even if multiple tests are sold in a single package.