1-800-557-6059 | TTY 711, 24/7. Tests must be approved, cleared or authorized by the. Reprinted with permission. 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. Tests must be approved, cleared or authorized by the. (For example, BinaxNOW offers a package with two tests included that would count as two individual tests). 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. For the time being, you'll have to submit a claim to get reimbursed after you buy tests. You can find a partial list of participating pharmacies at Medicare.gov. It doesnt need a doctors order. HCPCS code. All forms are printable and downloadable. Print the form and fill it out completely. You can find a partial list of participating pharmacies at Medicare.gov. 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. Once they have registered, the patient will be provided with an appointment window for up to seven days in advance. Aetna Medicare plans do not reimburse for OTC COVID-19 tests. 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. 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 . Providers will bill Medicare. 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. CPT is a registered trademark of the American Medical Association. 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. 12/03/2021 05:02 PM EST. The tests come at no extra cost. They may also order up to two sets of four at-home tests per household by visitingCOVIDtests.gov. All Rights Reserved. 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. Do not respond if you get a call, text or email about "free" coronavirus testing. 2. 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. Using FSA or HSA Funds. This policy for diagnostic and antibody testing applies to Commercial, Medicare and Medicaid plans.2. 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. 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. To help improve access to these tests, the Biden-Harris Administration is expanding access to free at-home kits through the federal government. 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. Go to the American Medical Association Web site. 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 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. Members should take their red, white and blue Medicare card when they pick up tests. Get PCR tests and antigen tests through a lab at no cost when a doctor or other health care professional orders it for you. On average this form takes 13 minutes to complete. COVID-19 Testing, Treatment, Coding & Reimbursement. If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. For people . 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 includes the testing only not necessarily the Physician visit. In addition, Aetna is waiving member cost-sharing for diagnostic testing related to COVID-19. 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. 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 . Even if the person gives you a different number, do not call it. Links to various non-Aetna sites are provided for your convenience only. 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 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). The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. For more information, see the attached Guidance for COVID-19 OTC Testing Coverage. New and revised codes are added to the CPBs as they are updated. Note: Each test is counted separately even if multiple tests are sold in a single package. No fee schedules, basic unit, relative values or related listings are included in 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. They may also order up to two sets of four at-home tests per household by visiting COVIDtests.gov. 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. By providing us with your email address, you agree to receive email communications from Aetna until you opt out of further emails. 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. Rates may vary for Commercial Plans based on factors such as billed charges or contractual terms. 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. Note: Each test is counted separately even if multiple tests are sold in a single package. 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. While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. 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, coverage may be mandated by applicable legal requirements of a State or the Federal government. Do not give out your Aetna member ID number or other personal information. 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. 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. Please note that copays, deductibles and coinsurance will apply according to the members benefit plan. The AMA is a third party beneficiary to this Agreement. By submitting a claim to Aetna for COVID-19 testing, providers acknowledge that the above amounts will be accepted as payment in full for each COVID-19 test performed, and that they will not seek additional reimbursement from members. Members should discuss any matters related to their coverage or condition with their treating provider. 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. 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). Some subtypes have five tiers of coverage. 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. Refer to the CDC website for the most recent guidance on antibody testing. 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. 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. Visit the World Health Organization for global news on COVID-19. In that case, you should be able to fill out the form and submit it on the insurance copmany's website, without printing out a physical copy. 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). Each site operated seven days a week, providing results to patients on-site, through the end of June. Do you want to continue? Subject to applicable law, Aetna may deny tests that do not meet medical necessity criteria. Please be sure to add a 1 before your mobile number, ex: 19876543210. Subject to applicable law, Aetna may deny tests that do not meet medical necessity criteria. 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. 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. Box 981106, El Paso, TX 79998-1106. Our ability to coordinate the availability of COVID-19 testing bolsters states efforts to manage the spread of the virus. Aetna will accept claims for reimbursement for tests purchased at out-of-network retailers. Any COVID-19 test ordered by your physician is covered by your insurance plan. If your reimbursement request is approved, a check will be mailed to you. For members with Aetna pharmacy benefits, you can submit a claim for reimbursement through your Aetna member website. For more information on test site locations in a specific state, please visit CVS.com. Members should take their red, white and blue Medicare card when they pick up their tests. If you dont see your patient coverage question here, let us know. Access trusted resources about COVID-19, including vaccine updates. Visit www.covidtests.gov to learn more. 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. 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 . CVS Health currently has more than 4,800 drive thru testing locations across the country offering COVID-19 testing. 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. 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. Covers up to eight (8) rapid antigen single-test kits or four (4) rapid antigen two-test kits per month. 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. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. This information helps us provide information tailored to your Medicare eligibility, which is based on age. On March 16, the CMS released details about how COVID-19 testing would be reimbursed to health care providers administering the tests. This includes those enrolled in a Medicare Advantage plan. 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 first is to pick them up at a pharmacy or store that your plan designates as "in-network.". Thanks! 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). This includes those enrolled in a Medicare Advantage plan. 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. 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. If you're on Medicare, there's also a . 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. Yes, patients must register in advance at CVS.comto schedule an appointment. Get the latest updates on every aspect of the pandemic. 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". Members should discuss any matters related to their coverage or condition with their treating provider. 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. Treating providers are solely responsible for medical advice and treatment of members. Any test ordered by your physician is covered by your insurance plan. Important: Use your Aetna ID that starts with a "W.". CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. They should check to see which ones are participating. This benefit does not apply to Aetna Better Heath of New York, since medical benefits are not covered. Patient samples collected at our COVID-19 drive-thru testing sites are sent offsite to independent, third-party labs who are responsible for processing and delivering the results, which we then communicate to patients. Save your COVID-19 test purchase receipts. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. As the insurer Aetna says . (Offer to transfer member to their PBMs customer service team.). Yes. 1Aetna will follow all federal and state mandates for insured plans, as required. If your reimbursement request is approved, a check will be mailed to you. If you do not intend to leave our site, close this message. Due to high demand for OTC at-home COVID-19 tests, supplies may be limited in some areas.

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