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. During the COVID-19 PHE, get one lab-performed test without a health care professional's order, at no cost. There is no obligation to enroll. Boxes of iHealth COVID-19 rapid test kits. 12/03/2021 05:02 PM EST. 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. 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. Referrals from University Health Services for off-campus medical care will again be required. If you bought or ordered an at-home COVID-19 test on or after January 15, 2022, you may be able to get reimbursed for the cost. However, you will likely be asked to scan a copy of . Some plans exclude coverage for services or supplies that Aetna considers medically necessary. 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. COVID-19 testing, vaccines, hospitalizations and related expenses will return to the standard coverage for in-network and out of network services. 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. 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 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. Reimbursement for 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV testing using any technique multiple types, subtypes (includes all targets) Reimbursement. CPT only Copyright 2022 American Medical Association. Visit the World Health Organization for global news on COVID-19. All claims received for Aetna-insured members going forward will be processed based on this new policy. Health benefits and health insurance plans contain exclusions and limitations. The requirement also applies to self-insured plans. 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. Others have four tiers, three tiers or two tiers. If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. 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. Aetna Medicaid Illinois is here for you during the coronavirus (COVID-19) pandemic, no matter what. 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. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. 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. Yes. 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. In addition, Aetna is waiving member cost-sharing for diagnostic testing related to COVID-19. Recently, the United States government made available four free at-home COVID-19 tests to each home address upon request. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. You are not eligible if you have Medicare, Medicare Supplement, Medicaid, or voluntary insurance. 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. Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search. PPE, like other disposable infection control supplies, is part of the cost of the underlying procedure. The policy . Under certain plans, if more than one service can be used to treat a covered person's dental condition, Aetna may decide to authorize coverage only for a less costly covered service provided that certain terms are met. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Any use of CPT outside of Aetna Precertification Code Search Tool should refer to the most Current Procedural Terminology which contains the complete and most current listing of CPT codes and descriptive terms. This requirement will continue as long as the COVID public health emergency lasts. 50 (218) By providing us with your email address, you agree to receive email communications from Aetna until you opt out of further emails. In case of a conflict between your plan documents and this information, the plan documents will govern. 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). Please refer to the FDA and CDC websites for the most up-to-date information. Claims for reimbursement for at home COVID-19 tests may be submitted online or via mail using the printable form. 2020 claims eligible for the 20% increase in the MS-DRG weighting factor will also be required to have a . In addition, health insurers now provide or reimburse the cost of up to eight home tests per month for most . LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM. 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. Thanks! Each main plan type has more than one subtype. ", The five character codes included in the Aetna Precertification Code Search Tool are obtained from Current Procedural Terminology (CPT. Applicable FARS/DFARS apply. Lab-based PCR home collection kits are not covered at this time by the OTC kit mandate. Who the tests are for (self or dependent), Your pharmacy plan should be able to provide that information. 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. For example, Binax offers a package with two tests that would count as two individual tests. Providers will bill Medicare. 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. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Your employer or health plan will have the best information on how to buy OTC COVID-19 tests that will be covered. Members must get them from participating pharmacies and health care providers. Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. Members should take their red, white and blue Medicare card when they pick up their 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 physicians orders1. As omicron has soared, the tests' availability seems to have plummeted. 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. Any test ordered by your physician is covered by your insurance plan. 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-results testing. Note: Each test is counted separately even if multiple tests are sold in a single package. This waiver may remain in place in states where mandated. 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: For more information on test site locations in a specific state visit CVS. Please refer to the FDA and CDC websites for the most up-to-date information. 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. Any COVID-19 test ordered by your physician is covered by your insurance plan. Biden free COVID tests plan. Tests must be FDA authorized in accordance with the requirements of the CARES Act. Your employer or health plan will have the best information on how to buy OTC COVID-19 tests that will be covered. Please note also that Dental Clinical Policy Bulletins (DCPBs) are regularly updated and are therefore subject to change. 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. Even if the person gives you a different number, do not call it. Important: Use your Aetna ID that starts with a "W.". For more information about the virus, please visit the CDC and/or WHO websites dedicated to this issue. Use Fill to complete blank online OTHERS pdf forms for free. CMS established these requirements to support faster high throughput COVID-19 diagnostic testing and to ensure all patients (not just Medicare patients) benefit from faster testing. Aetna will cover treatment of COVID-19 for our Medicare Advantage members. 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. Description. INDICAID COVID-19 Rapid Antigen Test, 1 Pack, 2 Tests Total, 4 Easy Steps & Results in 20 Minutes - Covid OTC Nasal Swab Test - HSA/FSA Reimbursement Eligible INDICAID $16.50 $ 16 . Yes. $51.33. 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. You can only get reimbursed for tests purchased on January 15, 2022 or later. . You can continue to use your HSA even if you lose your job. Using FSA or HSA Funds. 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. Go to the American Medical Association Web site. The Biden Administration said it will make sure every insured American can get a reimbursement by around Jan. 15. . The tests come at no extra cost. Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. Disclaimer of Warranties and Liabilities. The test can be done by any authorized testing facility. Tests must be FDA authorized in accordance with the requirements of the CARES Act. Medicare covers the updated COVID-19 vaccine at no cost to you. 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. The tests were shipped through the U.S. You can find a partial list of participating pharmacies at Medicare.gov. Home test kits may be eligible for reimbursement through OptumRx if the test was purchased after January 15, 2022. The tests, part of the administration's purchase of 500 million tests last . If you have private, employer-sponsored or student health commercial insurance youre eligible to get reimbursed for over-the-counter at-home COVID kits. At-home COVID-19 tests are excluded from all coupon discounts and promotions, including CarePass and ExtraBucks Rewards . This includes those enrolled in a Medicare Advantage plan. If you have health coverage through Cigna, you will need to print and fill out this at-home COVID-19 test reimbursement form. Effective April 4, 2022, Medicare will cover up to eight (8) at-home COVID-19 tests per person every 30 days or four (4) two-test, rapid antigen at-home tests every 30 days without a prescription. 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. You are now being directed to the CVS Health site. You, your employees and agents are authorized to use CPT only as contained in Aetna Precertification Code Search Tool solely for your own personal use in directly participating in health care programs administered by Aetna, Inc. You acknowledge that AMA holds all copyright, trademark and other rights in CPT. 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. Aetna will cover treatment of COVID-19 for our Medicare Advantage members. In case of a conflict between your plan documents and this information, the plan documents will govern. When billing, you must use the most appropriate code as of the effective date of the submission. 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). 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. Aetna participating providers should not bill members for Enhanced Infection Control and/or PPE. 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. Save your COVID-19 test purchase receipts. These guidelines do not apply to Medicare. 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). Aetna updated its website Friday with new frequently asked questions about the new requirement. Learn about extra benefits and well-being resources just for you, find testing locations, get answers to the most frequently asked questions regarding COVID-19 and tips to stay safe, and much more. All services deemed "never effective" are excluded from coverage. 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. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. Please be sure to add a 1 before your mobile number, ex: 19876543210. 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. 7/31/2021. 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. 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. Last update: February 1, 2023, 4:30 p.m. CT. To help improve access to these tests, the Biden-Harris Administration is expanding access to free at-home kits through the federal government. 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. 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 Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. 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. Who the tests are for (self or dependent), Your pharmacy plan should be able to provide that information. Treating providers are solely responsible for medical advice and treatment of members. If you don't see your testing and treatment questions here, let us know. Yes. 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. You can submit up to 8 tests per covered member per month. *The content below is not intended to be a substitute for professional medical advice, diagnosis or treatment. Aetna Medicare plans do not reimburse for OTC COVID-19 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 physicians orders1. Detect Covid-19 test. Some pharmacies may not be able to process claims for OTC COVID-19 tests at the pharmacy counter. CVS Health currently has more than 4,800 drive thru testing locations across the country offering COVID-19 testing. Members should take their red, white and blue Medicare card when they pick up tests. Postal Service will ship the tests directly to your door free of charge. Links to various non-Aetna sites are provided for your convenience only. 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. The test will be sent to a lab for processing. No. 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. 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. Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. When billing, you must use the most appropriate code as of the effective date of the submission. 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 . COVID-19 At-Home Test Reimbursement. 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. If your pharmacy benefits are not with Aetna, contact your pharmacy benefits administrator for instructions. Aetna will cover, without cost share, serological (antibody) tests that are ordered by a physician or authorized health care professional and are medically necessary. 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. 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. 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. 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. Stay up to date and find state resources, like testing sites, updated case counts, facts from the Centers for Disease Control and more. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Once completed you can sign your fillable form or send for signing. For more information on what tests are eligible for reimbursement, visit OptumRx's website. 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. While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. 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. 8/31/2021. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. 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. 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. 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. 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). 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. The AMA is a third party beneficiary to this Agreement. The Dental Clinical Policy Bulletins (DCPBs) describe Aetna's current determinations of whether certain services or supplies are medically necessary, based upon a review of available clinical information. 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. 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. 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. 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. 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). This information is neither an offer of coverage nor medical advice. The specimen should be sent to these laboratories using standard procedures. Our pharmacies and MinuteClinics are uniquely positioned to help address the pandemic and protect peoples health. Refer to the U.S. Food & Drug Administration on tests that are eligible for coverage. CPT is a registered trademark of the American Medical Association. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. You may opt out at any time. All telehealth/telemedicine, which includes all medical and behavioral health care .