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 American Medical Association (AMA) does not directly or indirectly practice medicine or dispense medical services. Coverage is in effect, per the mandate, until the end of the federal public health emergency. Reprinted with permission. You may opt out at any time. 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. Sign in or register at Caremark.com (You must be a CVS Caremark member) 160.103 in that the program has no relationship with individuals that would legally obligate the program to pay claims for some or all of the health care . 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. 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. You can use this money to pay for HSA eligible products. Yes, Aetna will cover tests approved, cleared or authorized by the U.S. Food and Drug Administration. Biden free COVID tests plan. The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. This mandate is in effect until the end of the federal public health emergency. (Offer to transfer member to their PBMs customer service team.). Last update: February 1, 2023, 4:30 p.m. CT. Subject to applicable law, Aetna may deny tests that do not meet medical necessity criteria. Links to various non-Aetna sites are provided for your convenience only. Please note: Your receipt must be dated January 15, 2022 or later to be 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. Detect Covid-19 test. Please refer to the FDA and CDC websites for the most up-to-date information. 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. 3Rates above are not applicable to Aetna Better Health Plans. 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. Disclaimer of Warranties and Liabilities. 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. OTC COVID-19 tests can be purchased at pharmacies, retail locations or online. 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. A list of approved tests is available from the U.S. Food & Drug Administration. Tests used for employment, school or recreational purposes are not eligible for reimbursement unless required by state law. 7/31/2021. 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. The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. 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. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. Some insurance companies, like Kaiser Permanente, Aetna and Blue Shield of California, are asking policyholders to request a reimbursement after purchasing a COVID-19 test by filling out a claim form. This coverage continues until the COVID-19 . 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. 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. Recently, the United States government made available four free at-home COVID-19 tests to each home address upon request. This Agreement will terminate upon notice if you violate its terms. For CVS Health testing initiatives, see section titled, COVID-19 drive-thru testing at CVS Pharmacy locations. Disclaimer of Warranties and Liabilities. If you buy a test at an out-of-network provider, your insurance may only cover $12 of the cost, and you'll be responsible for paying the rest. Americans with health insurance can get up to eight at-home coronavirus tests for free thanks to a new requirement. TTY users can call 1-877-486-2048. CVS Health currently has more than 4,800 locations across the country offering COVID-19 testing. In addition, Aetna is waiving member cost-sharing for diagnostic testing related to COVID-19. 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. For example, Binax offers a package with two tests that would count as two individual tests. Aetna defines a service as "never effective" when it is not recognized according to professional standards of safety and effectiveness in the United States for diagnosis, care or treatment. Aetna Medicaid Illinois is here for you during the coronavirus (COVID-19) pandemic, no matter what. While the Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. Go to the pharmacy website or call the relevant pharmacy to confirm participating locations and get details on how to order. Some subtypes have five tiers of coverage. Providers can seek reimbursement for uninsured patients through the Health Resources & Services Administration (HRSA) for COVID-19 testing, treatment and vaccine administration. In addition, health insurers now provide or reimburse the cost of up to eight home tests per month for most . Do not respond if you get a call, text or email about "free" coronavirus testing. 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. 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. CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. Tests must be FDA-authorized. The site said more information on how members can submit claims will soon be available. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. (For example, BinaxNOW offers a package with two tests included that would count as two individual tests). 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. For the time being, you'll have to submit a claim to get reimbursed after you buy tests. This also applies to Medicare and Medicaid plan coverage. 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". 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. Consumers who are fortunate enough to get their hands on over-the-counter, rapid COVID-19 tests will soon be reimbursed by their insurers for the cost of such devices under new . Some subtypes have five tiers of coverage. Treating providers are solely responsible for dental advice and treatment of members. A BinaxNow test shows a negative result for COVID-19. 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. Participating pharmacies offering COVID-19 Over-the-Counter (OTC) tests The following is a partial list of pharmacies participating in the Medicare COVID-19 Over-the-Counter (OTC) tests initiative. Once they have registered, the patient will be provided with an appointment window for up to seven days in advance. All forms are printable and downloadable. 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. Providers can seek reimbursement for uninsured patients through the Health Resources & Services Administration (HRSA) for COVID-19 testing, treatment and vaccine administration. The American Medical Association (AMA) does not directly or indirectly practice medicine or dispense medical services. Refer to the U.S. Food & Drug Administration on tests that are eligible for coverage. New and revised codes are added to the CPBs as they are updated. Your pharmacy plan should be able to provide that information. 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. 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 tests were shipped through the U.S. 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. 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. Print the form and fill it out completely. 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. All Rights Reserved. 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. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. 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. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. 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. Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". Any COVID-19 test ordered by your physician is covered by your insurance plan. 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. 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. Treating providers are solely responsible for medical advice and treatment of members. This search will use the five-tier subtype. Providers are encouraged to call their provider services representative for additional information. In addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members. This applies whether you purchased your health . This information is neither an offer of coverage nor medical advice. Treating providers are solely responsible for medical advice and treatment of members. 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)*. Yes, patients must register in advance at CVS.comto schedule an appointment. Health benefits and health insurance plans contain exclusions and limitations. 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. 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. Cigna. 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). For now, the only submission instructions are to fax the completed form to 859-410-2422 or physically mail it along with any receipts to the address on the back of your health insurance card. Lab-based PCR home collection kits are not covered at this time by the OTC kit mandate. 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. Aetna Medicare plans do not reimburse for OTC COVID-19 tests. 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). Aetna updated its website Friday with new frequently asked questions about the new requirement. At this time, covered tests are not subject to frequency limitations. Aetna Better Health will cover the treatment of COVID-19 or health complications associated with COVID-19. Applicable FARS/DFARS apply. . Tests must be purchased on or after January 15, 2022. Aetna Better Health plan pricing may be determined by each individual health plan in accordance with its state contracts. 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. Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search. This mandate is in effect until the end of the federal public health emergency. All telehealth/telemedicine, which includes all medical and behavioral health care . Please note that copays, deductibles and coinsurance will apply according to the members benefit plan. 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. 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 member cost-sharing waiver applies to all Commercial, Medicare and Medicaid lines of business. The reality may be far different, adding hurdles for . No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Blue Shield of California, Care First, Cigna, CVS Group/Aetna, and Kaiser Permanente) are currently relying only on reimbursement . Tests must be FDA authorized in accordance with the requirements of the CARES Act. Tests must be approved, cleared or authorized by the. The following rates are used for COVID-19 testing for commercial and Medicare plans, unless noted otherwise: Diagnostic testing/handling rates - Medicare. 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. For more information on test site locations in a specific state, please visit CVS.com. Rates may vary for Commercial Plans based on factors such as billed charges or contractual terms. 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. 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). 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. Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. Due to high demand for OTC at-home COVID-19 tests, supplies may be limited in some areas. Your pharmacy plan should be able to provide that information. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. 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. Members should take their red, white and blue Medicare card when they pick up their tests. Do not give out your Aetna member ID number or other personal information. No fee schedules, basic unit, relative values or related listings are included in CPT. An Abbott BinaxNOW Covid-19 antigen self test. Click on the COVID-19 Home Test Reimbursement Form link. 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. Medical Reimbursement: COVID Over-the-Counter Test Form (PDF) . 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. Lab-based PCR home collection kits are not covered at this time by the OTC kit mandate. Yes. Get started with your reimbursement request. You are not eligible if you have Medicare, Medicare Supplement, Medicaid, or voluntary insurance. 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. 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 are now being directed to the CVS Health site. Get a COVID-19 vaccine as soon as you can. Members should discuss any Dental Clinical Policy Bulletin (DCPB) 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. Get PCR tests and antigen tests through a lab at no cost when a doctor or other health care professional orders it for you. reimbursement scheme relies on people being able to find rapid COVID tests to buy either online or at their local pharmacy. Each site operated seven days a week, providing results to patients on-site, through the end of June. Stay up to date and find state resources, like testing sites, updated case counts, facts from the Centers for Disease Control and more. 50 (218) Providers will bill Medicare. 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. Coverage is in effect, per the mandate, until the end of the federal public health emergency. 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. Box 981106, El Paso, TX 79998-1106. As omicron has soared, the tests' availability seems to have plummeted. 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 testing, vaccines, hospitalizations and related expenses will return to the standard coverage for in-network and out of network services. 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 only get reimbursed for tests purchased on January 15, 2022 or later. In case of a conflict between your plan documents and this information, the plan documents will govern. Members should take their red, white and blue Medicare card when they pick up their tests. License to sue 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. This Agreement will terminate upon notice if you violate its terms. Any test ordered by your physician is covered by your insurance plan. Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. Please note also that Dental Clinical Policy Bulletins (DCPBs) are regularly updated and are therefore subject to change. (Offer to transfer member to their PBMs customer service team.). The Biden administration will launch a website where Americans can order free coronavirus tests on Jan. 19.. 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. 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 should take their red, white and blue Medicare card when they pick up their tests. Complete this form for each covered member. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. 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. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Aetna is in the process of developing a direct-to-consumer shipping option. Links to various non-Aetna sites are provided for your convenience only. Up to eight tests per 30-day period are covered. Testing will not be available at all CVS Pharmacy locations. If you do not intend to leave our site, close this message. 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). Access trusted resources about COVID-19, including vaccine updates. They should check to see which ones are participating. Note: Each test is counted separately even if multiple tests are sold in a single package. This benefit does not apply to Aetna Better Heath of New York, since medical benefits are not covered. Medicare now covers up to 8 over-the-counter COVID-19 tests each calendar month, at no cost to you. 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. This information helps us provide information tailored to your Medicare eligibility, which is based on age. Unlisted, unspecified and nonspecific codes should be avoided. CVS Health currently has more than 4,800 drive thru testing locations across the country offering COVID-19 testing. 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 . Access trusted resources about COVID-19, including vaccine updates. The member's benefit plan determines coverage. Visit the secure website, available through www.aetna.com, for more information. 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: Cue COVID-19 Test for home and over-the-counter (OTC) use. While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. 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). Aetna participating providers should not bill members for Enhanced Infection Control and/or PPE. 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. Tests must be used to diagnose a potential COVID-19 infection. On average this form takes 13 minutes to complete. Please log in to your secure account to get what you need. If you have any questions on filling out the form, please call 1-888-238-6240. CPT is a registered trademark of the American Medical Association. Our ability to coordinate the availability of COVID-19 testing bolsters states efforts to manage the spread of the virus. Pharmacists, in partnership with other health care providers, are well positioned to aid COVID-19 testing expansion. Claims for reimbursement for at home COVID-19 tests may be submitted online or via mail using the printable form. 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. Now, however, anyone in the U.S. can order a total of four free tests per household via COVIDtests.gov. 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 . Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. 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 test can be done by any authorized testing facility. Please visit your local CVS Pharmacy or request . Note: Each test is counted separately even if multiple tests are sold in a single package.