(Offer to transfer member to their PBMs customer service team.). No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM. 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. You are now being directed to the CVS Health site. Meanwhile, the agency said that Medicare pays for Covid-19 tests performed by a laboratory at no cost when the test is ordered by a physician or other health care provider. The 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. 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. The following are some of the national labs approved to do COVID-19 testing(other commercial labs are also approved): There are other participating commercial labs, hospitals and urgent care centers authorized to provide COVID-19 lab testing. 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). While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. This information is available on the HRSA website. This policy for diagnostic and antibody testing applies to Commercial, Medicare and Medicaid plans.2. 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. Boxes of iHealth COVID-19 rapid test kits. Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. Aetna Better Health plan pricing may be determined by each individual health plan in accordance with its state contracts. 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. 1-800-557-6059 | TTY 711, 24/7. Sign in or register at Caremark.com (You must be a CVS Caremark member) That's beginning to change, however. 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. Using FSA or HSA Funds. As the insurer Aetna says . No fee schedules, basic unit, relative values or related listings are included in CPT. Copyright 2015 by the American Society of Addiction Medicine. Disclaimer of Warranties and Liabilities. The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. 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. Kaiser members can go to " Coverage & Costs " and select "Submit a medical claim.". 4. 5. You can find a partial list of participating pharmacies at Medicare.gov. 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. Yes, Aetna will cover tests approved, cleared or authorized by the U.S. Food and Drug Administration. Links to various non-Aetna sites are provided for your convenience only. *As announced by CMS, starting January 1, 2021, Medicare will make an additional $25 add-on payment to laboratories for a COVID-19 diagnostic test run on high throughput technology if the laboratory: a) completes the test in two calendar days or less, and b) completes the majority of their COVID-19 diagnostic tests that use high throughput technology in two calendar days or less for all of their patients (not just their Medicare patients) in the previous month. Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. 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. 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. You are not eligible if you have Medicare, Medicare Supplement, Medicaid, or voluntary insurance. Please log in to your secure account to get what you need. Claim Coding, Submissions and Reimbursement. Our ability to coordinate the availability of COVID-19 testing bolsters states efforts to manage the spread of the virus. 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. Covers up to eight (8) rapid antigen single-test kits or four (4) rapid antigen two-test kits per month. You can find a partial list of participating pharmacies at Medicare.gov. This coverage continues until the COVID-19 . 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. CPT is a registered trademark of the American Medical Association. Refer to the U.S. Food & Drug Administration on tests that are eligible for coverage. 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. 12/03/2021 05:02 PM EST. Testing will not be available at all CVS Pharmacy locations. 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. 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. You can find a partial list of participating pharmacies at Medicare.gov. If you dont see your patient coverage question here, let us know. Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search. Laboratories using the test developed by the Center for Disease Control and Prevention (CDC) would be reimbursed $36 per test. 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. 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. The specimen should be sent to these laboratories using standard procedures. 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. It is only a partial, general description of plan or program benefits and does not constitute a contract. The tests come at no extra cost. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. 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. 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: 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. Unlisted, unspecified and nonspecific codes should be avoided. These reimbursement rates for COVID-19 diagnostic and antibody testing are based on rates announced by CMS. COVID-19 testing, vaccines, hospitalizations and related expenses will return to the standard coverage for in-network and out of network services. If your reimbursement request is approved, a check will be mailed to you. And other FAQs. Postal Service. For members with Aetna pharmacy benefits, you can submit a claim for reimbursement through your Aetna member website. Treating providers are solely responsible for medical advice and treatment of members. Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. 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). Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Aetna updated its website Friday with new frequently asked questions about the new requirement. The claim must include an itemized purchase receipt and the COVID-19 test's QR or UPC code, cut out of . It is only a partial, general description of plan or program benefits and does not constitute a contract. Now, however, anyone in the U.S. can order a total of four free tests per household via COVIDtests.gov. For more information and future updates, visit the CMS website and its newsroom. All Rights Reserved. This allows us to continue to help slow the spread of the virus. The member's benefit plan determines coverage. 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. 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. During the COVID-19 PHE, get one lab-performed test without a health care professional's order, at no cost. 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 policy . Others have four tiers, three tiers or two tiers. Aetna members can now receive reimbursement for test kits purchased on or after Jan. 15, 2022. 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). To help improve access to these tests, the Biden-Harris Administration is expanding access to free at-home kits through the federal government. Aetna is complying with the CMS coding guidelines for COVID-19 lab testing. For more information about the virus, please visit the CDC and/or WHO websites dedicated to this issue. Click on the COVID-19 Home Test Reimbursement Form link. The information you will be accessing is provided by another organization or vendor. 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. 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. The HRSA COVID-19 Uninsured Program is a claims reimbursement program for health care providers which does not meet the definition of a "health plan" as defined in section 1171(5) of the Social Security Act and in 45 C.F.R. Since January 2022, health insurance plans have been required to cover the cost of at-home rapid tests 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. If this happens, you can pay for the test, then submit a request for reimbursement. Members should take their red, white and blue Medicare card when they pick up their tests. CVS Health currently has more than 4,800 drive thru testing locations across the country offering COVID-19 testing. 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. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. Your commercial plan will reimburse you up to $12 per test. Providers will bill Medicare. This information is neither an offer of coverage nor medical advice. This includes those enrolled in a Medicare Advantage plan. These forms are usually returned by mail, and you'll most likely find the address for where to mail it on the form itself. 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. Testing, coding and reimbursement protocols and guidelines are established based on guidance from the Centers for Medicare & Medicaid Services (CMS), the Centers for Disease Control and Prevention (CDC), state and federal governments and other . New and revised codes are added to the CPBs as they are updated. If you are not on UHART's . 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. 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). This mandate is in effect until the end of the federal public health emergency. 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 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. Medicare member reimbursement amount per test may vary by Medicare plan. Note: Each test is counted separately even if multiple tests are sold in a single package. The member's benefit plan determines coverage. On average, the test results are typically available within 1-2 days, but may take longer due to local surges in COVID-19. The requirement also applies to self-insured plans. In addition, Aetna is waiving member cost-sharing for diagnostic testing related to COVID-19. Reprinted with permission. PPE, like other disposable infection control supplies, is part of the cost of the underlying procedure. Your plan may require reasonable documentation of proof of purchase with a claim for reimbursement for the cost of an OTC COVID-19 test. This mandate is in effect until the end of the federal public health emergency. At-home COVID-19 tests are excluded from all coupon discounts and promotions, including CarePass and ExtraBucks Rewards . 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 . 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. Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. For more information on what tests are eligible for reimbursement, visit OptumRx's website. Any test ordered by your physician is covered by your insurance plan. Applicable FARS/DFARS apply. If you suspect price gouging or a scam, contact your state . 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. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Print the form and fill it out completely. 7/31/2021. 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. Tests used for employment, school or recreational purposes are not eligible for reimbursement unless required by state law. (Offer to transfer member to their PBMs customer service team.). Complete this form for each covered member. LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). Providers can seek reimbursement for uninsured patients through the Health Resources & Services Administration (HRSA) for COVID-19 testing, treatment and vaccine administration. Aetna will cover, without cost share, serological (antibody) tests that are ordered by a physician or authorized health care professional and are medically necessary. TTY users can call 1-877-486-2048. Note: Each test is counted separately even if multiple tests are sold in a single package. 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. Please visit your local CVS Pharmacy or request . The American Medical Association (AMA) does not directly or indirectly practice medicine or dispense medical services. This applies whether you purchased your health . To make sure I didn't have COVID, I purchased a COVID test kit from Walgreens . In a . In addition, health insurers now provide or reimburse the cost of up to eight home tests per month for most . 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. Call 1-800-Medicare (1-800-633-4227) with any questions about this initiative. By providing us with your email address, you agree to receive email communications from Aetna until you opt out of further emails. Home test kits may be eligible for reimbursement through OptumRx if the test was purchased after January 15, 2022. This information is neither an offer of coverage nor medical advice. Each main plan type has more than one subtype. Patrick T. Fallon/AFP/Getty Images via Bloomberg. Please refer to the FDA and CDC websites for the most up-to-date information. Do you want to continue? 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. Members should discuss any matters related to their coverage or condition with their treating provider. Your employer or health plan will have the best information on how to buy OTC COVID-19 tests that will be covered. 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. Please log in to your secure account to get what you need. This requirement will continue as long as the COVID public health emergency lasts. Important: Use your Aetna ID that starts with a "W.". Use Fill to complete blank online OTHERS pdf forms for free. 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. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. 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.
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