These forms are usually returned by mail, and you'll most likely find the address for where to mail it on the form itself. Applicable FARS/DFARS apply. Members should take their red, white and blue Medicare card when they pick up their tests. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. Some subtypes have five tiers of coverage. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. 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-results testing. 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. CVS Health currently has more than 4,800 locations across the country offering COVID-19 testing. The member's benefit plan determines coverage. Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. 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. You may opt out at any time. As the insurer Aetna says . 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. Treating providers are solely responsible for medical advice and treatment of members. The free at-home COVID-19 test program ran from January 19, 2022 to September 2, 2022. Aetna generally does not reimburse doctors and dentists for Personal Protection Equipment. . For more information on test site locations in a specific state visit CVS. This requirement will continue as long as the COVID public health emergency lasts. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. All telehealth/telemedicine, which includes all medical and behavioral health care . 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. You can continue to use your HSA even if you lose your job. 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. Each main plan type has more than one subtype. The AMA is a third party beneficiary to this Agreement. Our pharmacies and MinuteClinics are uniquely positioned to help address the pandemic and protect peoples health. 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). Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. Lab-based PCR home collection kits are not covered at this time by the OTC kit mandate. Beginning January 15, 2022, individuals with private health insurance coverage or covered by a group health plan who purchase an over-the-counter COVID-19 diagnostic test authorized, cleared, or approved by the U.S. Food and Drug Administration (FDA) will be able to have those test costs covered by their plan or insurance. Reimbursement for using the CDC 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Panel. Reimbursement for 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV testing using any technique multiple types, subtypes (includes all targets) Reimbursement. Print the form and fill it out completely. 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. Visit the World Health Organization for global news on COVID-19. Go to the pharmacy website or call the relevant pharmacy to confirm participating locations and get details on how to order. Yes, Aetna will cover tests approved, cleared or authorized by the U.S. Food and Drug Administration. 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. Important: Use your Aetna ID that starts with a "W.". COVID-19 home test kit returns will not be accepted. Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. Tests used for employment, school or recreational purposes are not eligible for reimbursement unless required by state law. Tests must be FDA-authorized. The omicron surge may be receding in Michigan, but more than 13,000 in the state are still testing . 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. 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 you purchase a test outside of your preferred network, your insurance company can cap your reimbursement fee at $12meaning that even if your COVID test costs upwards of $30, you will still . Aetna is complying with the CMS coding guidelines for COVID-19 lab testing. Treating providers are solely responsible for medical advice and treatment of members. 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. Laboratories using the test developed by the Center for Disease Control and Prevention (CDC) would be reimbursed $36 per test. Patrick T. Fallon/AFP/Getty Images via Bloomberg. All claims received for Aetna-insured members going forward will be processed based on this new policy. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. Who the tests are for (self or dependent), Your pharmacy plan should be able to provide that information. It is only a partial, general description of plan or program benefits and does not constitute a contract. This waiver may remain in place in states where mandated. Your employer or health plan will have the best information on how to buy OTC COVID-19 tests that will be covered. Links to various non-Aetna sites are provided for your convenience only. 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. Disclaimer of Warranties and Liabilities. Medicare covered OTC COVID tests are provided by participating providers and pharmacies. 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. They may also order up to two sets of four at-home tests per household by visiting COVIDtests.gov. Home test kits may be eligible for reimbursement through OptumRx if the test was purchased after January 15, 2022. 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. No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM. Reprinted with permission. Aetna will accept claims for reimbursement for tests purchased at out-of-network retailers. You are now being directed to the CVS Health site. If you have private, employer-sponsored or student health commercial insurance youre eligible to get reimbursed for over-the-counter at-home COVID kits. Yes. CVS Health currently has more than 4,800 drive thru testing locations across the country offering COVID-19 testing. Home Test Kit Reimbursement. In a . As omicron has soared, the tests' availability seems to have plummeted. 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. 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. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. 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. Do not respond if you get a call, text or email about "free" coronavirus testing. You can only get reimbursed for tests purchased on January 15, 2022 or later. In addition, Aetna is waiving member cost-sharing for diagnostic testing related to COVID-19. . Coverage is available for members eligible with Medicare Part B FFS or Medicare Advantage Benefits. Visit the secure website, available through www.aetna.com, for more information. Members should discuss any matters related to their coverage or condition with their treating provider. 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: Some plans exclude coverage for services or supplies that Aetna considers medically necessary. 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. Box 981106, El Paso, TX 79998-1106. 1Aetna will follow all federal and state mandates for insured plans, as required. CPT is a registered trademark of the American Medical Association. 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. 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. Sign in or register at Caremark.com (You must be a CVS Caremark member) Please visit your local CVS Pharmacy or request . 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. This benefit does not apply to Aetna Better Heath of New York, since medical benefits are not covered. Members should discuss any matters related to their coverage or condition with their treating provider. 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. 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. You can find a partial list of participating pharmacies at Medicare.gov. Members should take their red, white and blue Medicare card when they pick up tests. Aetna updated its website Friday with new frequently asked questions about the new requirement. 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. 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 information helps us provide information tailored to your Medicare eligibility, which is based on age. 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). If you're on Medicare, there's also a . On average this form takes 13 minutes to complete. 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. 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. A list of approved tests is available from the U.S. Food & Drug Administration. *The content below is not intended to be a substitute for professional medical advice, diagnosis or treatment. 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 . CPT only copyright 2015 American Medical Association. The health insurance company Aetna has a guide on . For language services, please call the number on your member ID card and request an operator. 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. 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. 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. 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). Please note also that the ABA Medical Necessity Guidemay be updated and are, therefore, subject to change. If you don't see your testing and treatment questions here, let us know. PPE, like other disposable infection control supplies, is part of the cost of the underlying procedure. This search will use the five-tier subtype. Refer to the U.S. Food & Drug Administration on tests that are eligible for coverage. 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. Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. Members will need to submit a claim for reimbursement through the Aetna website and will receive a check once the claim is approved. 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 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 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. The tests, part of the administration's purchase of 500 million tests last . While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. Disclaimer of Warranties and Liabilities. New and revised codes are added to the CPBs as they are updated. The member's benefit plan determines coverage. Yes. This information is neither an offer of coverage nor medical advice. Pharmacists, in partnership with other health care providers, are well positioned to aid COVID-19 testing expansion. The tests come at no extra cost. For example, some UnitedHealthcare plans cover up to $40 of OTC products per quarter, which would cover the cost of 3 COVID-19 tests every 3 months (based on the $12 reimbursement rate being used . You are now being directed to CVS Caremark site. For more information on test site locations in a specific state, please visit CVS.com. 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. 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. 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. Some pharmacies may not be able to process claims for OTC COVID-19 tests at the pharmacy counter. 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. $35.92. Under President Trump's leadership, the Centers for Medicare & Medicaid Services (CMS) today announced new actions to pay for expedited coronavirus disease 2019 (COVID-19) test results. Some subtypes have five tiers of coverage. 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. At this time, covered tests are not subject to frequency limitations. Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. Aetna Medicare plans do not reimburse for OTC COVID-19 tests. Now, however, anyone in the U.S. can order a total of four free tests per household via COVIDtests.gov. Links to various non-Aetna sites are provided for your convenience only. And other FAQs. 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. If your reimbursement request is approved, a check will be mailed to you. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. 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. Note: Each test is counted separately even if multiple tests are sold in a single package. 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. For example, Binax offers a package with two tests that would count as two individual tests. 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. 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. Be sure to check your email for periodic updates. Consumers who are fortunate enough to get their hands on over-the-counter, rapid COVID-19 tests will soon be reimbursed by their insurers for the cost of such devices under new . If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. 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. This information is available on the HRSA website. 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. This Agreement will terminate upon notice if you violate its terms. Aetna complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, creed, religious ailiation, ancestry, sex gender . Those who have already purchased . Please be sure to add a 1 before your mobile number, ex: 19876543210. Cigna. No fee schedules, basic unit, relative values or related listings are included in CPT. Aetna participating providers should not bill members for Enhanced Infection Control and/or PPE. CPT is a registered trademark of the American Medical Association. Links to various non-Aetna sites are provided for your convenience only. Providers are encouraged to call their provider services representative for additional information. The requirement also applies to self-insured plans. 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). 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. For more information and future updates, visit the CMS website and its newsroom. Insurance companies are still figuring out the best system to do . 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). Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept". 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). Medicare covers one of these PCR kits per year at $0. For language services, please call the number on your member ID card and request an operator. 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. Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error.