They should check to see which ones are participating. When billing, you must use the most appropriate code as of the effective date of the submission. 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). The American Medical Association (AMA) does not directly or indirectly practice medicine or dispense medical services. Since January 2022, health insurance plans have been required to cover the cost of at-home rapid tests for COVID-19. Your pharmacy plan should be able to provide that information. Get the latest updates on every aspect of the pandemic. Please call your medical benefits administrator for your testing coverage details. If you're on Medicare, there's also a . Aetna Medicaid Illinois is here for you during the coronavirus (COVID-19) pandemic, no matter what. Others have four tiers, three tiers or two tiers. 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. CPT is a registered trademark of the American Medical Association. Children age 3 years and older are now eligible for testing at all of our COVID-19 drive-thru and rapid-result testing sites located at select CVS Pharmacy locations, effective March 5, 2021. CPT is a registered trademark of the American Medical Association. Our pharmacies and MinuteClinics are uniquely positioned to help address the pandemic and protect peoples health. This policy for diagnostic and antibody testing applies to Commercial, Medicare and Medicaid plans.2. 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. Medical Reimbursement: COVID Over-the-Counter Test Form (PDF) . The Biden Administration announced on December 2, 2021 (followed by detailed guidance released on January 10, 2022) that private insurers would be required to also begin covering the cost of rapid . 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 . Save your COVID-19 test purchase receipts. . Yes. 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. If you are still covered by a qualifying high-deductible health plan, you can continue to contribute as well. If this happens, you can pay for the test, then submit a request for reimbursement. 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. 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. 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 . Go to the pharmacy website or call the relevant pharmacy to confirm participating locations and get details on how to order. The member's benefit plan determines coverage. The member's benefit plan determines coverage. The member's benefit plan determines coverage. Health benefits and health insurance plans contain exclusions and limitations. CVS Health currently has more than 4,800 drive thru testing locations across the country offering COVID-19 testing. Refer to the CDC website for the most recent guidance on antibody testing. 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. Last update: February 1, 2023, 4:30 p.m. CT. 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 new states are Alabama, Arkansas, Colorado, Delaware, Iowa, Mississippi, Montana, North Dakota, Oregon and West Virginia. This search will use the five-tier subtype. Copyright 2015 by the American Society of Addiction Medicine. COVID-19 Testing, Treatment, Coding & Reimbursement. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. For example, Binax offers a package with two tests that would count as two individual tests. This mandate is in effect until the end of the federal public health emergency. 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 policy . Print the form and fill it out completely. Note: Each test is counted separately even if multiple tests are sold in a single package. Applicable FARS/DFARS apply. 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. This policy for diagnostic and antibody testing applies to Commercial, Medicare and Medicaid plans.2. 7/31/2021. Links to various non-Aetna sites are provided for your convenience only. The updated vaccine targets the original COVID-19 viral strain and 2 Omicron variants (BA.4/BA.5). Who the tests are for (self or dependent), Your pharmacy plan should be able to provide that information. For language services, please call the number on your member ID card and request an operator. Reimbursement for using the CDC 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Panel. You can find a partial list of participating pharmacies at Medicare.gov. Members will need to submit a claim for reimbursement through the Aetna website and will receive a check once the claim is approved. These forms are usually returned by mail, and you'll most likely find the address for where to mail it on the form itself. You are now being directed to the CVS Health site. This information is available on the HRSA website. Claims for reimbursement for at home COVID-19 tests may be submitted online or via mail using the printable form. Go to the American Medical Association Web site. For language services, please call the number on your member ID card and request an operator. 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. 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. However, you will likely be asked to scan a copy of . Your benefits plan determines coverage. If you do not intend to leave our site, close this message. Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". 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. The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. No fee schedules, basic unit, relative values or related listings are included in CPT. Even if the person gives you a different number, do not call it. On March 16, the CMS released details about how COVID-19 testing would be reimbursed to health care providers administering the tests. 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. Your employer or health plan will have the best information on how to buy OTC COVID-19 tests that will be covered. 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. Please report any scams by calling 1-800-447-8477 or online at https://tips.oig.hhs.gov/. For more information and future updates, visit the CMS website and its newsroom. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. This applies whether you purchased your health . Our ability to coordinate the availability of COVID-19 testing bolsters states efforts to manage the spread of the virus. All telehealth/telemedicine, which includes all medical and behavioral health care . 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. Routine testing for influenza, strep, and other respiratory infections without a COVID-19 test will be covered subject to applicable cost sharing under the members plan. Please note also that Dental Clinical Policy Bulletins (DCPBs) are regularly updated and are therefore subject to change. Some subtypes have five tiers of coverage. 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. 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. There is no obligation to enroll. Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. Links to various non-Aetna sites are provided for your convenience only. This includes those enrolled in a Medicare Advantage plan. If you don't see your testing and treatment questions here, let us know. 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. Aetna will cover treatment of COVID-19 for our Medicare Advantage members. In addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members. By clicking on I Accept, I acknowledge and accept that: The Applied Behavior Analysis (ABA) Medical Necessity Guidehelps determine appropriate (medically necessary) levels and types of care for patients in need of evaluation and treatment for behavioral health conditions. The site said more information on how members can submit claims will soon be available. The requirement also applies to self-insured plans. 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). Insurance companies are still figuring out the best system to do . No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Those using a non-CDC test will be reimbursed $51 . In case of a conflict between your plan documents and this information, the plan documents will govern. 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. Get the latest updates on every aspect of the pandemic. The COVID-19 At-Home Test Reimbursement form is 1 page long and contains: Please visit your local CVS Pharmacy or request . They should check to see which ones are participating. Tests must be approved, cleared or authorized by the. Any test ordered by your physician is covered by your insurance plan. 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. Members should take their red, white and blue Medicare card when they pick up their tests. New and revised codes are added to the CPBs as they are updated. Aetna is working to protect you from COVID-19 scams. You are now being directed to CVS Caremark site. Refer to the U.S. Food & Drug Administration on tests that are eligible for coverage. 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 . If your reimbursement request is approved, a check will be mailed to you. In a . For the time being, you'll have to submit a claim to get reimbursed after you buy tests. As of April 4, 2022, members with Medicare Part B can get up to eight over-the-counter COVID-19 tests each month while the COVID-19 public health emergency lasts. Patient samples collected at our COVID-19 drive-thru testing sites are sent offsite to independent, third-party labs who are responsible for processing and delivering the results, which we then communicate to patients. 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. 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. Aetna will cover, without cost share, serological (antibody) tests that are ordered by a physician or authorized health care professional and are medically necessary. 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. Your employer or health plan will have the best information on how to buy OTC COVID-19 tests that will be covered. When billing, you must use the most appropriate code as of the effective date of the submission. 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. Each site operated seven days a week, providing results to patients on-site, through the end of June. The omicron surge may be receding in Michigan, but more than 13,000 in the state are still 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. Learn more here. The first is to pick them up at a pharmacy or store that your plan designates as "in-network.". This information is available on the HRSA website. Some pharmacies may not be able to process claims for OTC COVID-19 tests at the pharmacy counter. In addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members. Aetna will accept claims for reimbursement for tests purchased at out-of-network retailers. 2Disclaimer: Regulations regarding testing for Aetna Medicaid members vary by state and, in some cases, may change in light of the current situation. 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. 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. 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. Due to high demand for OTC at-home COVID-19 tests, supplies may be limited in some areas. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. 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 . 50 (218) Yes. It is only a partial, general description of plan or program benefits and does not constitute a contract. Referrals from University Health Services for off-campus medical care will again be required. 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. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Members must get them from participating pharmacies and health care providers. Subject to applicable law, Aetna may deny tests that do not meet medical necessity criteria. Yes. Patients will need to pre-register, provide their insurance information as appropriate and verify their eligibility for testing. Treating providers are solely responsible for dental advice and treatment of members. Treating providers are solely responsible for medical advice and treatment of members. 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. Get a COVID-19 vaccine as soon as you can. 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. The specimen should be sent to these laboratories using standard procedures. This mandate is in effect until the end of the federal public health emergency. This also applies to Medicare and Medicaid plan coverage. Members should discuss any matters related to their coverage or condition with their treating provider. 1 This applies to Medicare, Medicaid, and private insurers. Pharmacists, in partnership with other health care providers, are well positioned to aid COVID-19 testing expansion. Although the federal government is not providing free tests at this time, it has taken steps to ensure that people are able to get free tests through their health insurance - Medicare included. 1Aetna will follow all federal and state mandates for insured plans, as required. 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. While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. Yes. Tests must be FDA authorized in accordance with the requirements of the CARES Act. Patients will need to pre-register, provide their insurance information as appropriate and verify their eligibility for testing. 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. Medicare now covers up to 8 over-the-counter COVID-19 tests each calendar month, at no cost to you. Members should take their red, white and blue Medicare card when they pick up tests. You wont be able to get reimbursed for tests* that: * May be subject to state-specific COVID-19 coverage mandates. The free at-home COVID-19 test program ran from January 19, 2022 to September 2, 2022. Tests used for employment, school or recreational purposes are not eligible for reimbursement unless required by state law. Routine testing for influenza, strep, and other respiratory infections without a COVID-19 test will be covered subject to applicable cost sharing under the members plan. Postal Service. For more information on what tests are eligible for reimbursement, visit OptumRx's website. On average this form takes 13 minutes to complete. Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. 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 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. Members must get them from participating pharmacies and health care providers. Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. This Agreement will terminate upon notice if you violate its terms. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. 1-800-557-6059 | TTY 711, 24/7. The tests were shipped through the U.S. At this time, covered tests are not subject to frequency limitations. Our ability to coordinate the availability of COVID-19 testing bolsters states efforts to manage the spread of the virus. The test can be done by any authorized testing facility. These guidelines do not apply to Medicare. Tests must be FDA authorized in accordance with the requirements of the CARES Act. For more information on test site locations in a specific state visit CVS. Any test ordered by your physician is covered by your insurance plan. The ABA Medical Necessity Guidedoes not constitute medical advice. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. Note: Each test is counted separately even if multiple tests are sold in a single package. 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. Please log in to your secure account to get what you need. (For example, BinaxNOW offers a package with two tests included that would count as two individual tests). Box 981106, El Paso, TX 79998-1106. You can administer the test and read the results yourself, without the help of a health care provider, Have to be sent to a lab (for example, Pixel, MyLab Box), Require a health care professional (doctor or nurse) to administer or read the test (for example, PCR or rapid tests). The reality may be far different, adding hurdles for . 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.
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