Any test ordered by your physician is covered by your insurance plan. In addition, health insurers now provide or reimburse the cost of up to eight home tests per month for most . Providers will bill Medicare. The health insurance company Aetna has a guide on . Pharmacists, in partnership with other health care providers, are well positioned to aid COVID-19 testing expansion. On March 16, the CMS released details about how COVID-19 testing would be reimbursed to health care providers administering the tests. Medicare covers one of these PCR kits per year at $0. You can also use it to pay for medical, dental and vision bills, including telehealth and COVID-19 treatment. All Rights Reserved. This information is neither an offer of coverage nor medical advice. 5. Yes, Aetna will cover tests approved, cleared or authorized by the U.S. Food and Drug Administration. 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. Members should take their red, white and blue Medicare card when they pick up their tests. Each main plan type has more than one subtype. Providers will bill Medicare. This information helps us provide information tailored to your Medicare eligibility, which is based on age. A parent or legal guardian must complete the on-line registration for all minor patients, and patients 3 to 15 years of age must be accompanied by a parent or legal guardian when they come to be tested. 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. The omicron surge may be receding in Michigan, but more than 13,000 in the state are still testing . 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. 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. A BinaxNow test shows a negative result for COVID-19. If you dont see your patient coverage question here, let us know. You can find a partial list of participating pharmacies at Medicare.gov. 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). If you have any questions on filling out the form, please call 1-888-238-6240. If your pharmacy benefits are not with Aetna, contact your pharmacy benefits administrator for instructions. 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. Members will need to submit a claim for reimbursement through the Aetna website and will receive a check once the claim is approved. 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. Please call your medical benefits administrator for your testing coverage details. CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. 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. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. 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. As the insurer Aetna says . This mandate is in effect until the end of the federal public health emergency. So if someone calls you to sell you an insurance policy or change your current policy even if the person says they represent Aetna call us first at the number on your ID card or 1-800-872-3862 (TTY: 711). Links to various non-Aetna sites are provided for your convenience only. Reimbursement for using the CDC 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Panel. Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept". Learn about extra benefits and well-being resources just for you, find testing locations, get answers to the most frequently asked questions regarding COVID-19 and tips to stay safe, and much more. No fee schedules, basic unit, relative values or related listings are included in CPT. You can submit up to 8 tests per covered member 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. Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. Providers are encouraged to call their provider services representative for additional information. The test can be done by any authorized testing facility. For more information and future updates, visit the CMS website and its newsroom. 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. Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. 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. 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. 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. Treating providers are solely responsible for medical advice and treatment of members. 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. Print the form and fill it out completely. Treating providers are solely responsible for dental advice and treatment of members. 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). Please note that copays, deductibles and coinsurance will apply according to the members benefit plan. 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. 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 is working to protect you from COVID-19 scams. 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. Aetna Medicare members can obtain OTC COVID-19 tests from participating providers and pharmacies, but will not be reimbursed for self-purchased tests. Disclaimer of Warranties and Liabilities. Yes. The member's benefit plan determines coverage. 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. Applicable FARS/DFARS apply. Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". Once they have registered, the patient will be provided with an appointment window forup to seven days in advance. All claims received for Aetna-insured members going forward will be processed based on this new policy. 8/31/2021. The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. 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 . You can only get reimbursed for tests purchased on January 15, 2022 or later. 1-800-557-6059 | TTY 711, 24/7. Treating providers are solely responsible for medical advice and treatment of members. 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 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. Once completed you can sign your fillable form or send for signing. Since then, CVS Health has continued to expand access to COVID-19 testing, establishing testing sites at more than 4,800 CVS Pharmacy locations across the country, including nearly 1,000 of which provide rapid-result testing. 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. 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. 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). Self-insured plan sponsors offered this waiver at their discretion. 4. 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. 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. Those using a non-CDC test will be reimbursed $51 . Medicare now covers up to 8 over-the-counter COVID-19 tests each calendar month, at no cost to you. If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. The U.S. 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. Medicare covers the vaccine for anyone who has Medicare due to their age, a disability, End-Stage Renal Disease (ESRD), or ALS (also called . 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. The member's benefit plan determines coverage. 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. While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. CPT is a registered trademark of the American Medical Association. Up to eight tests per 30-day period are 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. Members should take their red, white and blue Medicare card when they pick up their tests. 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. 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. 7/31/2021. Please note: Your receipt must be dated January 15, 2022 or later to be eligible for reimbursement. Go to the American Medical Association Web site. You can use this money to pay for HSA eligible products. 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 . Any test ordered by your physician is covered by your insurance plan. It is only a partial, general description of plan or program benefits and does not constitute a contract. The Biden Administration said it will make sure every insured American can get a reimbursement by around Jan. 15. . Sign in or register at Caremark.com (You must be a CVS Caremark member) 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. Patrick T. Fallon/AFP/Getty Images via Bloomberg. Recently, the United States government made available four free at-home COVID-19 tests to each home address upon request. Pharmacists, in partnership with other health care providers, are well positioned to aid COVID-19 testing expansion. ", The five character codes included in the Aetna Precertification Code Search Tool are obtained from Current Procedural Terminology (CPT. The tests come at no extra cost. These actions will be implemented under the amended Administrative Ruling (CMS-2020-1-R2) and coding instructions for the $25 add-on payment (HCPCS code U0005). Please report any scams by calling 1-800-447-8477 or online at https://tips.oig.hhs.gov/. The five character codes included in the Aetna Clinical Policy Bulletins (CPBs) are obtained from Current Procedural Terminology (CPT), copyright 2015 by the American Medical Association (AMA). (For example, BinaxNOW offers a package with two tests included that would count as two individual tests). Please note that copays, deductibles and coinsurance will apply according to the members benefit plan. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. Your employer or health plan will have the best information on how to buy OTC COVID-19 tests that will be covered. This policy for diagnostic and antibody testing applies to Commercial, Medicare and Medicaid plans.2. Members must get them from participating pharmacies and health care providers. This member cost-sharing waiver applies to all Commercial, Medicare and Medicaid lines of business. U0002. Refer to the U.S. Food & Drug Administration on tests that are eligible for coverage. New and revised codes are added to the CPBs as they are updated. Tests must be approved, cleared or authorized by the. LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). 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. 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. While the Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). 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. (Offer to transfer member to their PBMs customer service team.). 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. Thanks! Please be sure to add a 1 before your mobile number, ex: 19876543210. Please note also that the ABA Medical Necessity Guidemay be updated and are, therefore, subject to change. Access trusted resources about COVID-19, including vaccine updates. 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. Yes, patients must register in advance at CVS.com to schedule an appointment. These reimbursement rates for COVID-19 diagnostic and antibody testing are based on rates announced by CMS. Box 981106, El Paso, TX 79998-1106. Aetna generally does not reimburse doctors and dentists for Personal Protection Equipment. 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. 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). Save your COVID-19 test purchase receipts. Starting Saturday, private health plans are required to cover . They may also order up to two sets of four at-home tests per household by visitingCOVIDtests.gov. Reimbursement for 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV testing using any technique multiple types, subtypes (includes all targets) Reimbursement. Be sure to check your email for periodic updates. 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. The information you will be accessing is provided by another organization or vendor. Please note also that Dental Clinical Policy Bulletins (DCPBs) are regularly updated and are therefore subject to change. Copyright 2015 by the American Society of Addiction Medicine. Please be sure to add a 1 before your mobile number, ex: 19876543210. COVID-19 testing, vaccines, hospitalizations and related expenses will return to the standard coverage for in-network and out of network services. 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. 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. These forms are usually returned by mail, and you'll most likely find the address for where to mail it on the form itself. Please refer to the FDA and CDC websites for the most up-to-date information. 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. 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)*. 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 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. CPT only copyright 2015 American Medical Association. Treating providers are solely responsible for medical advice and treatment of members. This includes those enrolled in a Medicare Advantage plan. In case of a conflict between your plan documents and this information, the plan documents will govern. CVS Pharmacy, HealthHUB and MinuteClinic will continue to serve customers and patients. Go to the pharmacy website or call the relevant pharmacy to confirm participating locations and get details on how to order. You can find a partial list of participating pharmacies at Medicare.gov. 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. For example, Binax offers a package with two tests that would count as two individual tests. 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. In addition, coverage may be mandated by applicable legal requirements of a State or the Federal government. Home test kits may be eligible for reimbursement through OptumRx if the test was purchased after January 15, 2022. 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. (Offer to transfer member to their PBMs customer service team.). Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. The tests were shipped through the U.S. Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. Any test ordered by your physician is covered by your insurance plan. Your pharmacy plan should be able to provide that information. This waiver may remain in place in states where mandated. Note: Each test is counted separately even if multiple tests are sold in a single package. For more information on test site locations in a specific state, please visit CVS.com. 50 (218) You can find a partial list of participating pharmacies at Medicare.gov. 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). 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 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.