Who the tests are for (self or dependent), Your pharmacy plan should be able to provide that information. Links to various non-Aetna sites are provided for your convenience only. 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. Any test ordered by your physician is covered by your insurance plan. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. The test can be done by any authorized testing facility. National labs will not collect specimens for COVID-19 testing. 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 are encouraged to call their provider services representative for additional information. Self-insured plan sponsors offered this waiver at their discretion. Please note also that the ABA Medical Necessity Guidemay be updated and are, therefore, subject to change. Your employer or health plan will have the best information on how to buy OTC COVID-19 tests that will be covered. Aetna will cover, without cost share, serological (antibody) tests that are ordered by a physician or authorized health care professional and are medically necessary. Be sure to check your email for periodic updates. The Dental Clinical Policy Bulletins (DCPBs) describe Aetna's current determinations of whether certain services or supplies are medically necessary, based upon a review of available clinical information. Description. U0002. 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. 3Rates above are not applicable to Aetna Better Health Plans. For more information on test site locations in a specific state visit CVS. They may also order up to two sets of four at-home tests per household by visiting COVIDtests.gov. 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. This coverage continues until the COVID-19 . Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept". Patients will need to pre-register, provide their insurance information as appropriate and verify their eligibility for testing. This member cost-sharing waiver applies to all Commercial, Medicare and Medicaid lines of business. Reimbursement for using the CDC 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Panel. Complete this form for each covered member. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. A list of approved tests is available from the U.S. Food & Drug Administration. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. 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. Those using a non-CDC test will be reimbursed $51 . Self-insured plan sponsors offered this waiver at their discretion. Lab-based PCR home collection kits are not covered at this time by the OTC kit mandate. If you do not intend to leave our site, close this message. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. 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. Disclaimer of Warranties and Liabilities. 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. 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. 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. There is no obligation to enroll. 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). All Rights Reserved. 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: Yes. If this happens, you can pay for the test, then submit a request for reimbursement. It is only a partial, general description of plan or program benefits and does not constitute a contract. Refer to the CDC website for the most recent guidance on antibody testing. No fee schedules, basic unit, relative values or related listings are included in CPT. You are now being directed to the CVS Health site. 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. 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. The AMA is a third party beneficiary to this Agreement. 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. Please note: Your receipt must be dated January 15, 2022 or later to be eligible for reimbursement. Insurance companies are still figuring out the best system to do . The reality may be far different, adding hurdles for . The Biden administration will launch a website where Americans can order free coronavirus tests on Jan. 19.. Rates may vary for Commercial Plans based on factors such as billed charges or contractual terms. the labs to efficiently report and track testing services related to SARS-CoV-2 and will streamline the reporting and reimbursement for this test in the US. LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). 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. Please refer to the FDA and CDC websites for the most up-to-date information. Tests must be FDA authorized in accordance with the requirements of the CARES Act. Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. 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. Yes, patients must register in advance at CVS.com to schedule an appointment. The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. 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. These reimbursement rates for COVID-19 diagnostic and antibody testing are based on rates announced by CMS. Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. 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. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. 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. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. 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. Aetna is working to protect you from COVID-19 scams. 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. 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. However, you will likely be asked to scan a copy of . They should check to see which ones are participating. This member cost-sharing waiver applies to all Commercial, Medicare and Medicaid lines of business. The term precertification here means the utilization review process to determine whether the requested service, procedure, prescription drug or medical device meets the company's clinical criteria for coverage. If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. 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. CPT only copyright 2015 American Medical Association. Members should discuss any matters related to their coverage or condition with their treating provider. 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. 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. 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. (For example, BinaxNOW offers a package with two tests included that would count as two individual tests). The COVID-19 At-Home Test Reimbursement form is 1 page long and contains: Unlisted, unspecified and nonspecific codes should be avoided. CPT is a registered trademark of the American Medical Association. Members should not be charged for COVID-19 testing ordered by a provider acting within their authorized scope of care or administration of a COVID-19 vaccine. ", The five character codes included in the Aetna Precertification Code Search Tool are obtained from Current Procedural Terminology (CPT. Kaiser members can go to " Coverage & Costs " and select "Submit a medical claim.". The tests, part of the administration's purchase of 500 million tests last . Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. 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. The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. 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. 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 . Any test ordered by your physician is covered by your insurance plan. 50 (218) 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. 2Disclaimer: Regulations regarding testing for Aetna Medicaid members vary by state and, in some cases, may change in light of the current situation. Building on the companys comprehensive efforts to help slow the spread of the virus, we can bring safe and effective testingoptions closer to home and help increase access to testing options for even more individuals. 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. Go to the American Medical Association Web site. The updated vaccine targets the original COVID-19 viral strain and 2 Omicron variants (BA.4/BA.5). 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. (For example, BinaxNOW offers a package with two tests included that would count as two individual tests). Aetna will accept claims for reimbursement for tests purchased at out-of-network retailers. 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. Medicare covers one of these PCR kits per year at $0. The policy . Yes. 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 . 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. The information you will be accessing is provided by another organization or vendor. Our ability to coordinate the availability of COVID-19 testing bolsters states efforts to manage the spread of the virus. $35.92. However, applicable state mandates will take precedence with respect to fully insured plans and self-funded non-ERISA (e.g., government, school boards, church) plans. CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. Providers are encouraged to call their provider services representative for additional information. Please note also that Dental Clinical Policy Bulletins (DCPBs) are regularly updated and are therefore subject to change. If you are still covered by a qualifying high-deductible health plan, you can continue to contribute as well. The cost-sharing waiver applies to testing performed or ordered by in-network or out-of-network providers. In case of a conflict between your plan documents and this information, the plan documents will govern. Go to the pharmacy website or call the relevant pharmacy to confirm participating locations and get details on how to order. Those who have already purchased . 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. If you have health coverage through Cigna, you will need to print and fill out this at-home COVID-19 test reimbursement form. When you submit your claim, youll need to include: Youll also be asked to attest that the OTC kit is for personal use only, and not for employment, school, recreational or travel purposes. You, your employees and agents are authorized to use CPT only as contained in Aetna Precertification Code Search Tool solely for your own personal use in directly participating in health care programs administered by Aetna, Inc. You acknowledge that AMA holds all copyright, trademark and other rights in CPT. This information is neither an offer of coverage nor medical advice. Health benefits and health insurance plans contain exclusions and limitations. 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 log in to your secure account to get what you need. Any test ordered by your physician is covered by your insurance plan. Cigna. The health insurance company Aetna has a guide on . Please note that copays, deductibles and coinsurance will apply according to the members benefit plan. 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. That's beginning to change, however. 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. Links to various non-Aetna sites are provided for your convenience only. You can use this money to pay for HSA eligible products. The tests were shipped through the U.S. Once completed you can sign your fillable form or send for signing. . Aetna participating providers should not bill members for Enhanced Infection Control and/or PPE. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. In addition, Aetna is waiving member cost-sharing for diagnostic testing related to COVID-19. Your pharmacy plan should be able to provide that information. They should check to see which ones are participating. For more information, see the attached Guidance for COVID-19 OTC Testing Coverage. 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. 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. Yes. Coverage is in effect, per the mandate, until the end of the federal public health emergency. The test will be sent to a lab for processing. CPT is a registered trademark of the American Medical Association. 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. This mandate is in effect until the end of the federal public health emergency. All forms are printable and downloadable. Testing will not be available at all CVS Pharmacy locations. 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. Access trusted resources about COVID-19, including vaccine updates. 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. Lab-based PCR home collection kits are not covered at this time by the OTC kit mandate. Referrals from University Health Services for off-campus medical care will again be required. Tests used for employment, school or recreational purposes are not eligible for reimbursement unless required by state law.

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