Aetna participating providers should not bill members for Enhanced Infection Control and/or PPE. For more information on what tests are eligible for reimbursement, visit OptumRx's website. You should expect a response within 30 days. Your commercial plan will reimburse you up to $12 per test. COVID-19 home test kit returns will not be accepted. CVS Pharmacy, HealthHUB and MinuteClinic will continue to serve customers and patients. This is all part of our overall strategy to ramp-up access to easy-to-use, at-home tests at no cost," said U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra, in a . The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. Those using a non-CDC test will be reimbursed $51 . Care providers are responsible for submitting accurate claims in accordance with state and federal laws and UnitedHealthcare's reimbursement policies. 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. You are not eligible if you have Medicare, Medicare Supplement, Medicaid, or voluntary insurance. All claims received for Aetna-insured members going forward will be processed based on this new policy. 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. If you are still covered by a qualifying high-deductible health plan, you can continue to contribute as well. 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. Learn whats covered and the steps to get reimbursed. Sign in or register at Caremark.com (You must be a CVS Caremark member) Links to various non-Aetna sites are provided for your convenience only. For more information on test site locations in a specific state visit CVS. 50 (218) This mandate is in effect until the end of the federal public health emergency. The policy aligns with the Families First and CARES legislation and regulations requiring all health plans to provide coverage of COVID-19 testing without cost share. 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. 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. Providers can seek reimbursement for uninsured patients through the Health Resources & Services Administration (HRSA) for COVID-19 testing, treatment and vaccine administration. New and revised codes are added to the CPBs as they are updated. If you bought or ordered an at-home COVID-19 test on or after January 15, 2022, you may be able to get reimbursed for the cost. An Abbott BinaxNOW Covid-19 antigen self test. Once they have registered, the patient will be provided with an appointment window forup to seven days in advance. 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. Home Test Kit Reimbursement. LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). Aetna will accept claims for reimbursement for tests purchased at out-of-network retailers. 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. You are now being directed to the CVS Health site. CPT is a registered trademark of the American Medical Association. Please visit your local CVS Pharmacy or request . No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. $35.92. Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. Please note also that the ABA Medical Necessity Guidemay be updated and are, therefore, subject to change. Cigna. (Offer to transfer member to their PBMs customer service team.). 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. The omicron surge may be receding in Michigan, but more than 13,000 in the state are still testing . Visit the World Health Organization for global news on COVID-19. Applicable FARS/DFARS apply. The CDC recommends that anyone: who has symptoms of COVID-19 who has been in close contact with a person known to have COVID-19: or who lives in or has recently traveled from an area with ongoing spread of COVID-19, should contact their health care provider and be tested. Do not give out your Aetna member ID number or other personal information. 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. U0002. If you're on Medicare, there's also a . Please log in to your secure account to get what you need. The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. Americans with health insurance can get up to eight at-home coronavirus tests for free thanks to a new requirement. 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. 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. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. As omicron has soared, the tests' availability seems to have plummeted. Tests must be approved, cleared or authorized by the. Aetna will cover, without cost share, serological (antibody) tests that are ordered by a physician or authorized health care professional and are medically necessary. 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. At this time, covered tests are not subject to frequency limitations. The COVID-19 At-Home Test Reimbursement form is 1 page long and contains: These guidelines do not apply to Medicare. You can find a partial list of participating pharmacies at Medicare.gov. Each main plan type has more than one subtype. The site said more information on how members can submit claims will soon be available. In case of a conflict between your plan documents and this information, the plan documents will govern. 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). Please note also that Dental Clinical Policy Bulletins (DCPBs) are regularly updated and are therefore subject to change. Last update: February 1, 2023, 4:30 p.m. CT. A list of approved tests is available from the U.S. Food & Drug Administration. 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. 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. Some subtypes have five tiers of coverage. It does not mean precertification as defined by Texas law, as a reliable representation of payment of care or services to fully insured HMO and PPO members. Description. 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. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. The ABA Medical Necessity Guidedoes not constitute medical advice. 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). In the event a claim has already been processed prior to this policy going into effect, members should contact Customer Service so the claim can be reprocessed accordingly. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Go to the pharmacy website or call the relevant pharmacy to confirm participating locations and get details on how to order. 2. Copyright 2015 by the American Society of Addiction Medicine. 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. This allows us to continue to help slow the spread of the virus. In addition, Aetna is waiving member cost-sharing for diagnostic testing related to COVID-19. The first is to pick them up at a pharmacy or store that your plan designates as "in-network.". Self-insured plan sponsors offered this waiver at their discretion. Please report any scams by calling 1-800-447-8477 or online at https://tips.oig.hhs.gov/. Members will need to submit a claim for reimbursement through the Aetna website and will receive a check once the claim is approved. 1-800-557-6059 | TTY 711, 24/7. The member's benefit plan determines coverage. Members should take their red, white and blue Medicare card when they pick up their tests. A list of approved tests is available from the U.S. Food & Drug Administration. Blue Shield of California, Care First, Cigna, CVS Group/Aetna, and Kaiser Permanente) are currently relying only on reimbursement . Patrick T. Fallon/AFP/Getty Images via Bloomberg. You are now being directed to CVS caremark site. If you don't see your testing and treatment questions here, let us know. Your employer or health plan will have the best information on how to buy OTC COVID-19 tests that will be covered. For language services, please call the number on your member ID card and request an operator. This member cost-sharing waiver applies to all Commercial, Medicare and Medicaid lines of business. 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: You are not eligible if you have Medicare, Medicare Supplement, Medicaid, or voluntary insurance. Access trusted resources about COVID-19, including vaccine updates. 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. Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. This policy for diagnostic and antibody testing applies to Commercial, Medicare and Medicaid plans.2. The AMA is a third party beneficiary to this Agreement. Some pharmacies may not be able to process claims for OTC COVID-19 tests at the pharmacy counter. Your plan may require reasonable documentation of proof of purchase with a claim for reimbursement for the cost of an OTC COVID-19 test. Be sure to check your email for periodic updates. Your pharmacy plan should be able to provide that information. 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. 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. 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 example, Binax offers a package with two tests that would count as two individual tests. Use Fill to complete blank online OTHERS pdf forms for free. You can only get reimbursed for tests purchased on January 15, 2022 or later. 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. 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. 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. Note: Each test is counted separately even if multiple tests are sold in a single package. The cost-sharing waiver applies to testing performed or ordered by in-network or out-of-network providers. If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. If your reimbursement request is approved, a check will be mailed to you. 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). 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. 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. If your reimbursement request is approved, a check will be mailed to you. 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. You can use this money to pay for HSA eligible products. Download the form below and mail to: Aetna, P.O. 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. 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. 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. Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. Coverage is in effect, per the mandate, until the end of the federal public health emergency. In addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members. CVS Pharmacy, HealthHUB and MinuteClinic will continue to serve customers and patients. This also applies to Medicare and Medicaid plan coverage. There is no obligation to enroll. 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. CPT is a registered trademark of the American Medical Association. 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. Aetna Medicare members can obtain OTC COVID-19 tests from participating providers and pharmacies, but will not be reimbursed for self-purchased tests. This waiver may remain in place in states where mandated. Who the tests are for (self or dependent), Your pharmacy plan should be able to provide that information. 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). . You can also use it to pay for medical, dental and vision bills, including telehealth and COVID-19 treatment. Disclaimer of Warranties and Liabilities. On average, the test results are typically available within 1-2 days, but may take longer due to local surges in COVID-19. 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. This coverage continues until the COVID-19 . 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. Reimbursement for 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV testing using any technique multiple types, subtypes (includes all targets) Reimbursement. 2Disclaimer: Regulations regarding testing for Aetna Medicaid members vary by state and, in some cases, may change in light of the current situation. Each site operated seven days a week, providing results to patients on-site, through the end of June. . Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. Recently, the United States government made available four free at-home COVID-19 tests to each home address upon request. This includes the testing only not necessarily the Physician visit. Tests must be approved, cleared or authorized by the. Providers are encouraged to call their provider services representative for additional information. Claims for reimbursement for at home COVID-19 tests may be submitted online or via mail using the printable form. 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. 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. 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. Please note: Your receipt must be dated January 15, 2022 or later to be eligible for reimbursement. In addition, Aetna is waiving member cost-sharing for diagnostic testing related to COVID-19. 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. To help improve access to these tests, the Biden-Harris Administration is expanding access to free at-home kits through the federal government. Medicare covers the vaccine for anyone who has Medicare due to their age, a disability, End-Stage Renal Disease (ESRD), or ALS (also called . No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM. 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. . Using FSA or HSA Funds. 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. If you are not on UHART's . The tests come at no extra cost. (Offer to transfer member to their PBMs customer service team.). Due to high demand for OTC at-home COVID-19 tests, supplies may be limited in some areas. The AMA is a third party beneficiary to this Agreement. 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. 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 . Note: Each test is counted separately even if multiple tests are sold in a single package. reimbursement scheme relies on people being able to find rapid COVID tests to buy either online or at their local pharmacy. The specimen should be sent to these laboratories using standard procedures. 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 .