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. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Last update: February 1, 2023, 4:30 p.m. CT. Tests must be FDA-authorized. There is no obligation to enroll. Subject to applicable law, Aetna may deny tests that do not meet medical necessity criteria. If you have private, employer-sponsored or student health commercial insurance youre eligible to get reimbursed for over-the-counter at-home COVID kits. 1 This applies to Medicare, Medicaid, and private insurers. 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. 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 Health currently has more than 4,800 locations across the country offering COVID-19 testing. In addition, health insurers now provide or reimburse the cost of up to eight home tests per month for most . Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. Please note that copays, deductibles and coinsurance will apply according to the members benefit plan. Your employer or health plan will have the best information on how to buy OTC COVID-19 tests that will be covered. Be sure to check your email for periodic updates. If you are still covered by a qualifying high-deductible health plan, you can continue to contribute as well. You can also call Aetna Member Services by . In addition, Aetna is waiving member cost-sharing for diagnostic testing related to COVID-19. 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. 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). This benefit does not apply to Aetna Better Heath of New York, since medical benefits are not covered. 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. Members will need to submit a claim for reimbursement through the Aetna website and will receive a check once the claim is approved. If you do not intend to leave our site, close this message. As the insurer Aetna says . 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. Coverage is available for members eligible with Medicare Part B FFS or Medicare Advantage Benefits. Health benefits and health insurance plans contain exclusions and limitations. Visit the secure website, available through www.aetna.com, for more information. 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. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. COVID-19 home test kit returns will not be accepted. You are not eligible if you have Medicare, Medicare Supplement, Medicaid, or voluntary insurance. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. Referrals from University Health Services for off-campus medical care will again be required. Aetna Medicare members can obtain OTC COVID-19 tests from participating providers and pharmacies, but will not be reimbursed for self-purchased tests. 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. 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. 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). PPE, like other disposable infection control supplies, is part of the cost of the underlying procedure. 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. Home Test Kit Reimbursement. Patients will need to pre-register, provide their insurance information as appropriate and verify their eligibility for testing. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Once they have registered, the patient will be provided with an appointment window forup to seven days in advance. Yes. The Biden Administration said it will make sure every insured American can get a reimbursement by around Jan. 15. . You are now being directed to the CVS Health site. Under the federal governments current guidelines, tests are eligible if: Eligible tests include single-use, cartridge-based tests (for example, Flowflex, BinaxNow or Ongo). Yes. 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. The site said more information on how members can submit claims will soon be available. Aetna generally does not reimburse doctors and dentists for Personal Protection Equipment. This applies whether you purchased your health . Reprinted with permission. The AMA is a third party beneficiary to this Agreement. For the time being, you'll have to submit a claim to get reimbursed after you buy tests. Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. The reality may be far different, adding hurdles for . The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". No fee schedules, basic unit, relative values or related listings are included in CPT. Aetna updated its website Friday with new frequently asked questions about the new requirement. Cue COVID-19 Test for home and over-the-counter (OTC) use. Providers can seek reimbursement for uninsured patients through the Health Resources & Services Administration (HRSA) for COVID-19 testing, treatment and vaccine administration. Get the latest updates on every aspect of the pandemic. 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). Box 981106, El Paso, TX 79998-1106. Since January 2022, health insurance plans have been required to cover the cost of at-home rapid tests for COVID-19. 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. CPT only Copyright 2022 American Medical Association. You can find a partial list of participating pharmacies at Medicare.gov. Postal Service will ship the tests directly to your door free of charge. Covers up to eight (8) rapid antigen single-test kits or four (4) rapid antigen two-test kits per month. The HRSA COVID-19 Uninsured Program is a claims reimbursement program for health care providers which does not meet the definition of a "health plan" as defined in section 1171(5) of the Social Security Act and in 45 C.F.R. Stay up to date and find state resources, like testing sites, updated case counts, facts from the Centers for Disease Control and more. Members must get them from participating pharmacies and health care providers. 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. U0002. 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. This member cost-sharing waiver applies to all Commercial, Medicare and Medicaid lines of business. 2Disclaimer: Regulations regarding testing for Aetna Medicaid members vary by state and, in some cases, may change in light of the current situation. 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. 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. 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. Some subtypes have five tiers of coverage. To help improve access to these tests, the Biden-Harris Administration is expanding access to free at-home kits through the federal government. (For example, BinaxNOW offers a package with two tests included that would count as two individual tests). 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. Get PCR tests and antigen tests through a lab at no cost when a doctor or other health care professional orders it for you. 3Rates above are not applicable to Aetna Better Health Plans. Laboratories using the test developed by the Center for Disease Control and Prevention (CDC) would be reimbursed $36 per test. You can also use it to pay for medical, dental and vision bills, including telehealth and COVID-19 treatment. Please note: Your receipt must be dated January 15, 2022 or later to be eligible for reimbursement. 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. 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. . Providers are encouraged to call their provider services representative for additional information. And other FAQs. Important: Use your Aetna ID that starts with a "W.". This is all part of our overall strategy to ramp-up access to easy-to-use, at-home tests at no cost," said U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra, in a . Of note: Aetna specifies that "tests must be used to diagnose a potential Covid-19 infection" and tests used for employment, school or recreational purposes aren't eligible for reimbursement. You can find a partial list of participating pharmacies at Medicare.gov. This waiver may remain in place in states where mandated. This information is neither an offer of coverage nor medical advice. 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. Treating providers are solely responsible for medical advice and treatment of members. If you have private, employer-sponsored or student health commercial insurance youre eligible to get reimbursed for over-the-counter at-home COVID kits. Description. 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. Members should take their red, white and blue Medicare card when they pick up their tests. Links to various non-Aetna sites are provided for your convenience only. New and revised codes are added to the CPBs as they are updated. When billing, you must use the most appropriate code as of the effective date of the submission. 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. 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. 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). No. Please log in to your secure account to get what you need. Treating providers are solely responsible for medical advice and treatment of members. CVS Health currently has more than 4,800 drive thru testing locations across the country offering COVID-19 testing. 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. You can find a partial list of participating pharmacies at Medicare.gov. 5. As omicron has soared, the tests' availability seems to have plummeted. Coverage is in effect, per the mandate, until the end of the federal public health emergency. This mandate is in effect until the end of the federal public health emergency. The Biden administration is selling a key part of its pandemic strategy as free at-home Covid-19 tests for all. This page provides MassHealth Coronavirus Disease (COVID-19) guidance and information for all MassHealth providers. 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: For CVS Health testing initiatives, see section titled, COVID-19 drive-thru testing at CVS Pharmacy locations. 50 (218) 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 . The tests were shipped through the U.S. 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. In addition, coverage may be mandated by applicable legal requirements of a State or the Federal government. 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. The member's benefit plan determines coverage. Between January 15 and January 30, just 0.5 percent of Blue Cross Blue Shield of Massachusetts subscribers filed COVID test reimbursement claims, WBUR reported last month. 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. Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. This includes those enrolled in a Medicare Advantage plan. All forms are printable and downloadable. 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. You should expect a response within 30 days. These reimbursement rates for COVID-19 diagnostic and antibody testing are based on rates announced by CMS. For example, some UnitedHealthcare plans cover up to $40 of OTC products per quarter, which would cover the cost of 3 COVID-19 tests every 3 months (based on the $12 reimbursement rate being used . Access trusted resources about COVID-19, including vaccine updates. Your employer or health plan will have the best information on how to buy OTC COVID-19 tests that will be covered. 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. 2. The tests come at no extra cost. 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. Your pharmacy plan should be able to provide that information. Blue Shield of California, Care First, Cigna, CVS Group/Aetna, and Kaiser Permanente) are currently relying only on reimbursement . Members should not be charged for COVID-19 testing ordered by a provider acting within their authorized scope of care or administration of a COVID-19 vaccine. Aetna Better Health members with questions about these specific benefits are encouraged to call the member services phone number on the back of their ID cards. The ABA Medical Necessity Guidedoes not constitute medical advice. 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. 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. 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. 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. Refer to the U.S. Food & Drug Administration on tests that are eligible for coverage. This policy for diagnostic and antibody testing applies to Commercial, Medicare and Medicaid plans.2. Yes. Do not give out your Aetna member ID number or other personal information. Click on the COVID-19 Home Test Reimbursement Form link. The tests come at no extra cost. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. Lab-based PCR home collection kits are not covered at this time by the OTC kit mandate. 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. In case of a conflict between your plan documents and this information, the plan documents will govern. The ABA Medical Necessity Guidedoes not constitute medical advice. HCPCS code. Self-insured plan sponsors offered this waiver at their discretion. 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. 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. Get started with your reimbursement request. Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. When billing, you must use the most appropriate code as of the effective date of the submission. CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. However, applicable state mandates will take precedence with respect to fully insured plans and self-funded non-ERISA (e.g., government, school boards, church) plans. This mandate is in effect until the end of the federal public health emergency.
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