Your plan may require reasonable documentation of proof of purchase with a claim for reimbursement for the cost of an OTC COVID-19 test. 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. 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. 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. CPT only copyright 2015 American Medical Association. Box 981106, El Paso, TX 79998-1106. Aetna is reaching out to the commercial labs about their ability to provide the COVID-19 testing. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Please log in to your secure account to get what you need. A list of approved tests is available from the U.S. Food & Drug Administration. Your benefits plan determines coverage. 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. 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. The reality may be far different, adding hurdles for . Go to the pharmacy website or call the relevant pharmacy to confirm participating locations and get details on how to order. 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. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Links to various non-Aetna sites are provided for your convenience only. CPT is a registered trademark of the American Medical Association. On average, the test results are typically available within 1-2 days, but may take longer due to local surges in COVID-19. Get PCR tests and antigen tests through a lab at no cost when a doctor or other health care professional orders it for you. 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. No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM. When submitting COVID-19-related claims, follow the coding guidelines and guidance outlined below and review the CDC guideline for ICD-10-CM . 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. 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. Our ability to coordinate the availability of COVID-19 testing bolsters states efforts to manage the spread of the virus. Providers can seek reimbursement for uninsured patients through the Health Resources & Services Administration (HRSA) for COVID-19 testing, treatment and vaccine administration. 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. It will show you whether a drug is covered or not covered, but the tier information may not be the same as it is for your specific plan. Care providers are responsible for submitting accurate claims in accordance with state and federal laws and UnitedHealthcare's reimbursement policies. Please note that copays, deductibles and coinsurance will apply according to the members benefit plan. By providing us with your email address, you agree to receive email communications from Aetna until you opt out of further emails. Visit www.covidtests.gov to learn more. Sign in or register at Caremark.com (You must be a CVS Caremark member) . 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. Please note: Your receipt must be dated January 15, 2022 or later to be eligible for reimbursement. 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. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Aetna generally does not reimburse doctors and dentists for Personal Protection Equipment. 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. Providers will bill Medicare. Our pharmacies and MinuteClinics are uniquely positioned to help address the pandemic and protect peoples health. 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: 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. 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. You can continue to use your HSA even if you lose your job. Description. If you don't see your testing and treatment questions here, let us know. If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. $35.92. All Rights Reserved. For more information about the virus, please visit the CDC and/or WHO websites dedicated to this issue. 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. Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. Aetna members can now receive reimbursement for test kits purchased on or after Jan. 15, 2022. 1Aetna will follow all federal and state mandates for insured plans, as required. Go to the American Medical Association Web site. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. 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. 3Rates above are not applicable to Aetna Better Health Plans. You may opt out at any time. 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 Biden administration is selling a key part of its pandemic strategy as free at-home Covid-19 tests for all. Your employer or health plan will have the best information on how to buy OTC COVID-19 tests that will be covered. CMS previously took action in April 2020 by increasing the Medicare payment to laboratories for high throughput COVID-19 diagnostic tests from approximately $51 to $100 per test. This benefit does not apply to Aetna Better Heath of New York, since medical benefits are not covered. If you do not intend to leave our site, close this message. 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. Some subtypes have five tiers of coverage. You can find a partial list of participating pharmacies at Medicare.gov. Providers can seek reimbursement for uninsured patients through the Health Resources & Services Administration (HRSA) for COVID-19 testing, treatment and vaccine administration. The site said more information on how members can submit claims will soon be available. Yes, patients must register in advance at CVS.comto schedule an appointment. CVS Pharmacy, HealthHUB and MinuteClinic will continue to serve customers and patients. Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. The AMA is a third party beneficiary to this Agreement. Do you want to continue? Members must get them from participating pharmacies and health care providers. Kaiser members can go to " Coverage & Costs " and select "Submit a medical claim.". Do you want to continue? You are now being directed to the CVS Health site. Under the federal governments current guidelines, tests are eligible if: Eligible tests include single-use, cartridge-based tests (for example, Flowflex, BinaxNow or Ongo). Each main plan type has more than one subtype. LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). The health insurance company Aetna has a guide on . 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). It will show you whether a drug is covered or not covered, but the tier information may not be the same as it is for your specific plan. Home Test Kit Reimbursement. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. 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 policy for diagnostic and antibody testing applies to Commercial, Medicare and Medicaid plans.2. Members should take their red, white and blue Medicare card when they pick up their tests. 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). Your pharmacy plan should be able to provide that information. Coverage is in effect, per the mandate, until the end of the federal public health emergency. It is only a partial, general description of plan or program benefits and does not constitute a contract. All Rights Reserved. 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 . 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. 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. Tests must be used to diagnose a potential COVID-19 infection. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. Aetna will cover treatment of COVID-19 for our Medicare Advantage members. 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. Aetnas health plans do not cover serological (antibody) tests that are for purposes of: return to work or school or for general health surveillance or self-surveillance or self-diagnosis, except as required by applicable law. The information you will be accessing is provided by another organization or vendor. This information is neither an offer of coverage nor medical advice. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. 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 . PPE, like other disposable infection control supplies, is part of the cost of the underlying procedure. Yes. For more information and future updates, visit the CMS website and its newsroom. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. Tests must be approved, cleared or authorized by the. Get the latest updates on every aspect of the pandemic. Boxes of iHealth COVID-19 rapid test kits. U0002. Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this product. 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. You can also use it to pay for medical, dental and vision bills, including telehealth and COVID-19 treatment. 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. You wont be able to get reimbursed for tests* that: * May be subject to state-specific COVID-19 coverage mandates. Send it to the address shown on the form. Call 1-800-Medicare (1-800-633-4227) with any questions about this initiative. Postal Service. Lab-based PCR home collection kits are not covered at this time by the OTC kit mandate. Members should take their red, white and blue Medicare card when they pick up tests. Our ability to coordinate the availability of COVID-19 testing bolsters states efforts to manage the spread of the virus. Some pharmacies may not be able to process claims for OTC COVID-19 tests at the pharmacy counter. 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. The member's benefit plan determines coverage. The American Medical Association (AMA) does not directly or indirectly practice medicine or dispense medical services. (For example, BinaxNOW offers a package with two tests included that would count as two individual tests). Click on the COVID-19 Home Test Reimbursement Form link. The specimen should be sent to these laboratories using standard procedures. Any test ordered by your physician is covered by your insurance plan. Aetna is in the process of developing a direct-to-consumer shipping option. In addition, Aetna is waiving member cost-sharing for diagnostic testing related to COVID-19. A list of approved tests is available from the U.S. Food & Drug Administration. 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. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. If this happens, you can pay for the test, then submit a request for reimbursement. COVID-19 Testing, Treatment, Coding & Reimbursement. Coverage is in effect, per the mandate, until the end of the federal public health emergency. Important: Use your Aetna ID that starts with a "W.". This Agreement will terminate upon notice if you violate its terms. This mandate is in effect until the end of the federal public health emergency. In the event that a member disagrees with a coverage determination, member may be eligible for the right to an internal appeal and/or an independent external appeal in accordance with applicable federal or state law. The discussion, analysis, conclusions and positions reflected in the Clinical Policy Bulletins (CPBs), including any reference to a specific provider, product, process or service by name, trademark, manufacturer, constitute Aetna's opinion and are made without any intent to defame. If you are not on UHART's . 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. . Members must get them from participating pharmacies and health care providers. Yes. Providers will bill Medicare. If in-patient treatment was required for a member with a positive COVID-19 diagnosis prior to this announcement it will be processed in accordance with this new policy. 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. CPT is a registered trademark of the American Medical Association. Note: Each test is counted separately even if multiple tests are sold in a single package. 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. Go to the American Medical Association Web site. Aetna updated its website Friday with new frequently asked questions about the new requirement. Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its affiliates (Aetna). In addition, coverage may be mandated by applicable legal requirements of a State or the Federal government. Disclaimer of Warranties and Liabilities. Please refer to the FDA and CDC websites for the most up-to-date information. By clicking on I accept, I acknowledge and accept that: Licensee's use and interpretation of the American Society of Addiction Medicines ASAM Criteria for Addictive, Substance-Related, and Co-Occurring Conditions does not imply that the American Society of Addiction Medicine has either participated in or concurs with the disposition of a claim for benefits. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. This search will use the five-tier subtype. As omicron has soared, the tests' availability seems to have plummeted.