Your plan may require reasonable documentation of proof of purchase with a claim for reimbursement for the cost of an OTC COVID-19 test. 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. (For example, BinaxNOW offers a package with two tests included that would count as two individual tests). 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. Go to the American Medical Association Web site. Links to various non-Aetna sites are provided for your convenience only. 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. Aetna will cover treatment of COVID-19 for our Medicare Advantage members. 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 search will use the five-tier subtype. Applicable FARS/DFARS apply. 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). Note: Each test is counted separately even if multiple tests are sold in a single package. As omicron has soared, the tests' availability seems to have plummeted. The requirement also applies to self-insured plans. Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. Under President Trump's leadership, the Centers for Medicare & Medicaid Services (CMS) today announced new actions to pay for expedited coronavirus disease 2019 (COVID-19) test results. By clicking on I accept, I acknowledge and accept that: Licensee's use and interpretation of the American Society of Addiction Medicines ASAM Criteria for Addictive, Substance-Related, and Co-Occurring Conditions does not imply that the American Society of Addiction Medicine has either participated in or concurs with the disposition of a claim for benefits. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Members should discuss any matters related to their coverage or condition with their treating provider. 7/31/2021. Pharmacists, in partnership with other health care providers, are well positioned to aid COVID-19 testing expansion. 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. 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. The tests were shipped through the U.S. The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. CVS Pharmacy, HealthHUB and MinuteClinic will continue to serve customers and patients. 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 will cover, without cost share, serological (antibody) tests that are ordered by a physician or authorized health care professional and are medically necessary. 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. 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. This requirement will continue as long as the COVID public health emergency lasts. You should expect a response within 30 days. Once they have registered, the patient will be provided with an appointment window forup to seven days in advance. 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. The test can be done by any authorized testing facility. Since January 2022, health insurance plans have been required to cover the cost of at-home rapid tests for COVID-19. 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. Stay up to date and find state resources, like testing sites, updated case counts, facts from the Centers for Disease Control and more. Any test ordered by your physician is covered by your insurance plan. Unlisted, unspecified and nonspecific codes should be avoided. Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. Patients will need to pre-register, provide their insurance information as appropriate and verify their eligibility for testing. This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. This does not apply to Medicare. Aetna Medicaid Illinois is here for you during the coronavirus (COVID-19) pandemic, no matter what. They may also order up to two sets of four at-home tests per household by visitingCOVIDtests.gov. 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. The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. The cost-sharing waiver applies to testing performed or ordered by in-network or out-of-network providers. The Biden administration will launch a website where Americans can order free coronavirus tests on Jan. 19.. Subject to applicable law, Aetna may deny tests that do not meet medical necessity criteria. 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. 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. For more information about the virus, please visit the CDC and/or WHO websites dedicated to this issue. HCPCS code. 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: Please call your medical benefits administrator for your testing coverage details. 8/31/2021. 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. In addition, coverage may be mandated by applicable legal requirements of a State or the Federal government. 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. Aetna Medicare plans do not reimburse for OTC COVID-19 tests. A list of approved tests is available from the U.S. Food & Drug Administration. The tests, part of the administration's purchase of 500 million tests last . 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. 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. 2020 claims eligible for the 20% increase in the MS-DRG weighting factor will also be required to have a . Who the tests are for (self or dependent), Your pharmacy plan should be able to provide that information. 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. Tests used for employment, school or recreational purposes are not eligible for reimbursement unless required by state law. The COVID-19 At-Home Test Reimbursement form is 1 page long and contains: 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. While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. The Biden Administration said it will make sure every insured American can get a reimbursement by around Jan. 15. . Any test ordered by your physician is covered by your insurance plan. Access trusted resources about COVID-19, including vaccine updates. This information is neither an offer of coverage nor medical advice. ", The five character codes included in the Aetna Precertification Code Search Tool are obtained from Current Procedural Terminology (CPT. Aetna will cover, without cost share, serological (antibody) tests that are ordered by a physician or authorized health care professional and are medically necessary. This allows us to continue to help slow the spread of the virus. Those who have already purchased . If you have health coverage through Cigna, you will need to print and fill out this at-home COVID-19 test reimbursement form. New and revised codes are added to the CPBs as they are updated. 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. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. These guidelines do not apply to Medicare. Yes. Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. Treating providers are solely responsible for medical advice and treatment of members. They may also order up to two sets of four at-home tests per household by visiting COVIDtests.gov. 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. 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. Unlisted, unspecified and nonspecific codes should be avoided. 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. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. 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. Copyright 2015 by the American Society of Addiction Medicine. Reprinted with permission. 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. If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. 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 must get them from participating pharmacies and health care providers. All claims received for Aetna-insured members going forward will be processed based on this new policy. 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. 1Aetna will follow all federal and state mandates for insured plans, as required. Commercial labs are in the process of updating their provider community about their capabilities and how to order tests. Reimbursement for 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV testing using any technique multiple types, subtypes (includes all targets) Reimbursement. Yes. Tests must be FDA-authorized. (For example, BinaxNOW offers a package with two tests included that would count as two individual tests). 1Aetna will follow all federal and state mandates for insured plans, as required. Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept". Access trusted resources about COVID-19, including vaccine updates. 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. Pharmacists, in partnership with other health care providers, are well positioned to aid COVID-19 testing expansion. 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. On average this form takes 13 minutes to complete. 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. Yes, patients must register in advance at CVS.com to schedule an appointment. . Please report any scams by calling 1-800-447-8477 or online at https://tips.oig.hhs.gov/. This information is available on the HRSA website. Referrals from University Health Services for off-campus medical care will again be required. 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. Aetna participating providers should not bill members for Enhanced Infection Control and/or PPE. . If in-patient treatment was required for a member with a positive COVID-19 diagnosis prior to this announcement it will be processed in accordance with this new policy. Your pharmacy plan should be able to provide that information. Members should discuss any matters related to their coverage or condition with their treating provider. 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. If you purchase a test outside of your preferred network, your insurance company can cap your reimbursement fee at $12meaning that even if your COVID test costs upwards of $30, you will still . You are not eligible if you have Medicare, Medicare Supplement, Medicaid, or voluntary insurance. 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. 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. 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. This policy for diagnostic and antibody testing applies to Commercial, Medicare and Medicaid plans.2. Our ability to coordinate the availability of COVID-19 testing bolsters states efforts to manage the spread of the virus. 1 This applies to Medicare, Medicaid, and private insurers. CVS Health currently has more than 4,800 locations across the country offering COVID-19 testing. Refer to the U.S. Food & Drug Administration on tests that are eligible for coverage. Aetna is in the process of developing a direct-to-consumer shipping option. If your pharmacy benefits are not with Aetna, contact your pharmacy benefits administrator for instructions. Providers will bill Medicare. The U.S. The test will be sent to a lab for processing. This Agreement will terminate upon notice if you violate its terms. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. For example, Binax offers a package with two tests that would count as two individual tests. 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. 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. This policy for diagnostic and antibody testing applies to Commercial, Medicare and Medicaid plans.2. Do not give out your Aetna member ID number or other personal information. 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. Call 1-800-Medicare (1-800-633-4227) with any questions about this initiative. And other FAQs. Please note: Your receipt must be dated January 15, 2022 or later to be eligible for reimbursement. You can only get reimbursed for tests purchased on January 15, 2022 or later. Save your COVID-19 test purchase receipts. Lab-based PCR home collection kits are not covered at this time by the OTC kit mandate. 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. 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. 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 . An Abbott BinaxNOW Covid-19 antigen self test. 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. Go to the pharmacy website or call the relevant pharmacy to confirm participating locations and get details on how to order. Home test kits may be eligible for reimbursement through OptumRx if the test was purchased after January 15, 2022. 3Rates above are not applicable to Aetna Better Health Plans. Between January 15 and January 30, just 0.5 percent of Blue Cross Blue Shield of Massachusetts subscribers filed COVID test reimbursement claims, WBUR reported last month. 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. Get the latest updates on every aspect of the pandemic. Note: Each test is counted separately even if multiple tests are sold in a single package. . In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision.