No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Boxes of iHealth COVID-19 rapid test kits. 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. In response to COVID-19, MassHealth has taken steps to create flexibilities for providers; expand benefits, including coverage of services delivered via telehealth; and expand eligibility for residents of the Commonwealth. 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 requirement also applies to self-insured plans. 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. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. And other FAQs. All Rights Reserved. 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. Aetna Medicare plans do not reimburse for OTC COVID-19 tests. Laboratories that complete a majority of COVID-19 diagnostic tests run on high throughput technology within two days will be paid $100 per test by Medicare, while laboratories that take longer will receive $75 per test. Thanks! If you have any questions on filling out the form, please call 1-888-238-6240. 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). Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Each main plan type has more than one subtype. 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. Please note that copays, deductibles and coinsurance will apply according to the members benefit plan. 3Rates above are not applicable to Aetna Better Health Plans. Some subtypes have five tiers of coverage. CPT is a registered trademark of the American Medical Association. Note: Each test is counted separately even if multiple tests are sold in a single package. In addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members. 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 . 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. 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. Pharmacists, in partnership with other health care providers, are well positioned to aid COVID-19 testing expansion. 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. Commercial labs are in the process of updating their provider community about their capabilities and how to order tests. 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. 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. The ABA Medical Necessity Guidedoes not constitute medical advice. These forms are usually returned by mail, and you'll most likely find the address for where to mail it on the form itself. Just enter your mobile number and well text you a link to download the Aetna Health app from the App Store or on Google Play. For more information, see the attached Guidance for COVID-19 OTC Testing Coverage. If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Print the form and fill it out completely. Treating providers are solely responsible for dental advice and treatment of members. In addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members. 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. If your reimbursement request is approved, a check will be mailed to you. Some subtypes have five tiers of coverage. Members should take their red, white and blue Medicare card when they pick up their tests. 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. 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 . The free at-home COVID-19 test program ran from January 19, 2022 to September 2, 2022. Treating providers are solely responsible for medical advice and treatment of members. 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. Aetna Medicaid Illinois is here for you during the coronavirus (COVID-19) pandemic, no matter what. While you can no longer get free COVID-19 test kits from the federal government, if you have health insurance, you're covered for eight free over-the-counter, at-home COVID-19 tests each month.So if you have health insurance through your employer, or if you have a plan through the Affordable Care Act's marketplace, each person on your plan can get eight tests per month. 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. You can find a partial list of participating pharmacies at Medicare.gov. 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. This search will use the five-tier subtype. Others have four tiers, three tiers or two tiers. In effort to expand testing capabilities, U.S. Department of Health & Human Services (DHS) authorized pharmacists to order and administer COVID-19 tests, including serology tests, that the FDA has authorized. HCPCS code. If you have private, employer-sponsored or student health commercial insurance youre eligible to get reimbursed for over-the-counter at-home COVID kits. Aetna will accept claims for reimbursement for tests purchased at out-of-network retailers. Do not give out your Aetna member ID number or other personal information. You can only get reimbursed for tests purchased on January 15, 2022 or later. 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. The test can be done by any authorized testing facility. 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. Once they have registered, the patient will be provided with an appointment window forup to seven days in advance. Once they have registered, the patient will be provided with an appointment window for up to seven days in advance. 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). 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. 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. Download the form below and mail to: Aetna, P.O. Patients will need to pre-register, provide their insurance information as appropriate and verify their eligibility for testing. This policy for diagnostic and antibody testing applies to Commercial, Medicare and Medicaid plans.2. 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. They should check to see which ones are participating. These reimbursement rates for COVID-19 diagnostic and antibody testing are based on rates announced by CMS. Refer to the CDC website for the most recent guidance on antibody testing. Tests must be approved, cleared or authorized by the. 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. COVID-19 home test kit returns will not be accepted. It doesnt need a doctors order. 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. Our pharmacies and MinuteClinics are uniquely positioned to help address the pandemic and protect peoples health. Stay up to date and find state resources, like testing sites, updated case counts, facts from the Centers for Disease Control and more. That's beginning to change, however. 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. If you don't see your testing and treatment questions here, let us know. 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 includes the testing only not necessarily the Physician visit. Do not respond if you get a call, text or email about "free" coronavirus testing. The omicron surge may be receding in Michigan, but more than 13,000 in the state are still testing . Links to various non-Aetna sites are provided for your convenience only. Please report any scams by calling 1-800-447-8477 or online at https://tips.oig.hhs.gov/. 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. Aetna generally does not reimburse doctors and dentists for Personal Protection Equipment. . Our ability to coordinate the availability of COVID-19 testing bolsters states efforts to manage the spread of the virus. Aetna complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, creed, religious ailiation, ancestry, sex gender . The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. In addition, health insurers now provide or reimburse the cost of up to eight home tests per month for most . 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)*. Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. 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. Aetna will cover treatment of COVID-19 for our Medicare Advantage members. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. This information is available on the HRSA website. Reprinted with permission. If your pharmacy benefits are not with Aetna, contact your pharmacy benefits administrator for instructions. They should check to see which ones are participating. Links to various non-Aetna sites are provided for your convenience only. For more information on what tests are eligible for reimbursement, visit OptumRx's website. 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. For example, Binax offers a package with two tests that would count as two individual tests. For members with Aetna pharmacy benefits, you can submit a claim for reimbursement through your Aetna member website. A BinaxNow test shows a negative result for COVID-19. 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. 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. 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. Please log in to your secure account to get what you need. Go to the pharmacy website or call the relevant pharmacy to confirm participating locations and get details on how to order. Those using a non-CDC test will be reimbursed $51 . This mandate is in effect until the end of the federal public health emergency. Your benefits plan determines coverage. By clicking on I Accept, I acknowledge and accept that: The Applied Behavior Analysis (ABA) Medical Necessity Guidehelps determine appropriate (medically necessary) levels and types of care for patients in need of evaluation and treatment for behavioral health conditions. Aetna Better Health plan pricing may be determined by each individual health plan in accordance with its state contracts. Also, new federal guidelines allow members with private, employer-sponsored and student health commercial insurance to request reimbursement for over-the-counter COVID-19 diagnostic tests that are purchased on or after January 15, 2022 without physician's orders 1.This mandate is in effect until the end of the federal . 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. 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. If you dont see your patient coverage question here, let us know. The claim must include an itemized purchase receipt and the COVID-19 test's QR or UPC code, cut out of . 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. Go to the American Medical Association Web site. If a member is billed for Enhanced Infection Control and/or PPE by a participating provider, he/she should contact Aetna customer service at the phone number listed on the members ID card. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. 2Disclaimer: Regulations regarding testing for Aetna Medicaid members vary by state and, in some cases, may change in light of the current situation. When submitting COVID-19-related claims, follow the coding guidelines and guidance outlined below and review the CDC guideline for ICD-10-CM . For more information on test site locations in a specific state visit CVS. This includes those enrolled in a Medicare Advantage plan. Please be sure to add a 1 before your mobile number, ex: 19876543210. Patients will need to pre-register, provide their insurance information as appropriate and verify their eligibility for testing. Links to various non-Aetna sites are provided for your convenience only. While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. 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. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Postal Service will ship the tests directly to your door free of charge. 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. This benefit does not apply to Aetna Better Heath of New York, since medical benefits are not covered. Reimbursement for using the CDC 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Panel. It is only a partial, general description of plan or program benefits and does not constitute a contract. 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. Aetna's conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered (i.e., will be paid for by Aetna). You can use this money to pay for HSA eligible products. Call 1-800-Medicare (1-800-633-4227) with any questions about this initiative. CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to the implied warranties of merchantability and fitness for a particular purpose. For language services, please call the number on your member ID card and request an operator. Send it to the address shown on the form. Use Fill to complete blank online OTHERS pdf forms for free. 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. Yes. The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. 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. The ABA Medical Necessity Guidedoes not constitute medical advice. You can also call Aetna Member Services by . 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. 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. 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. Treating providers are solely responsible for medical advice and treatment of members. The tests were shipped through the U.S. 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. . Note: Each test is counted separately even if multiple tests are sold in a single package. If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. Subject to applicable law, Aetna may deny tests that do not meet medical necessity criteria. There are two main ways to purchase these tests. The Biden administration will launch a website where Americans can order free coronavirus tests on Jan. 19.. Get started with your reimbursement request. 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 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. 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. For more information on test site locations in a specific state, please visit CVS.com. Any test ordered by your physician is covered by your insurance plan. Access trusted resources about COVID-19, including vaccine updates. 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. Any test ordered by your physician is covered by your insurance plan. When billing, you must use the most appropriate code as of the effective date of the submission. 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. 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). reimbursement scheme relies on people being able to find rapid COVID tests to buy either online or at their local pharmacy. Important: Use your Aetna ID that starts with a "W.". COVID-19 At-Home Test Reimbursement. 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.