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Aetna Medicare plans do not reimburse for OTC COVID-19 tests. Testing, coding and reimbursement protocols and guidelines are established based on guidance from the Centers for Medicare & Medicaid Services (CMS), the Centers for Disease Control and Prevention (CDC), state and federal governments and other . Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". Detect Covid-19 test. The free at-home COVID-19 test program ran from January 19, 2022 to September 2, 2022. This is all part of our overall strategy to ramp-up access to easy-to-use, at-home tests at no cost," said U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra, in a . Please note that copays, deductibles and coinsurance will apply according to the members benefit plan. 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 . MINNEAPOLIS On Tuesday, White House Press Secretary Jen Psaki tweeted that the Biden administration will make sure every insured American can get reimbursed for their at-home COVID tests. For the time being, you'll have to submit a claim to get reimbursed after you buy tests. 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. 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. 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. Yes. 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. The following rates are used for COVID-19 testing for commercial and Medicare plans, unless noted otherwise: Diagnostic testing/handling rates - Medicare. Health benefits and health insurance plans contain exclusions and limitations. Referrals from University Health Services for off-campus medical care will again be required. Lab-based PCR home collection kits are not covered at this time by the OTC kit mandate. 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. All services deemed "never effective" are excluded from coverage. If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. 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. To help improve access to these tests, the Biden-Harris Administration is expanding access to free at-home kits through the federal government. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. At this time, covered tests are not subject to frequency limitations. Once they have registered, the patient will be provided with an appointment window forup to seven days in advance. 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). CVS Health currently has more than 4,800 locations across the country offering COVID-19 testing. 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. COVID-19 At-Home Test Reimbursement. If you bought or ordered an at-home COVID-19 test on or after January 15, 2022, you may be able to get reimbursed for the cost. Visit the World Health Organization for global news on COVID-19. Lab-based PCR home collection kits are not covered at this time by the OTC kit mandate. Links to various non-Aetna sites are provided for your convenience only. If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. CVS Health At Home COVID-19 Test Kit; Walgreens At-Home COVID-19 Test Kit; 12/23/2022: Abbott Diagnostics Scarborough, Inc. BinaxNOW COVID-19 Antigen Self Test 03/31/2021: You can find a partial list of participating pharmacies at Medicare.gov. 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. This search will use the five-tier subtype. CVS Pharmacy, HealthHUB and MinuteClinic will continue to serve customers and patients. Box 981106, El Paso, TX 79998-1106. And other FAQs. It is only a partial, general description of plan or program benefits and does not constitute a contract. 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. 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. 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. 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. These guidelines do not apply to Medicare. 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. 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. 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 . 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. The test can be done by any authorized testing facility. Members should take their red, white and blue Medicare card when they pick up their tests. 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. 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. 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. Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. Aetna is reaching out to the commercial labs about their ability to provide the COVID-19 testing. Any test ordered by your physician is covered by your insurance plan. 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. Treating providers are solely responsible for medical advice and treatment of members. Tests must be used to diagnose a potential COVID-19 infection. 1Aetna will follow all federal and state mandates for insured plans, as required. You are now being directed to the CVS Health site. 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 case of a conflict between your plan documents and this information, the plan documents will govern. Cue COVID-19 Test for home and over-the-counter (OTC) use. 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. If you don't see your testing and treatment questions here, let us know. 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. Tests used for employment, school or recreational purposes are not eligible for reimbursement unless required by state law. 2. Covers up to eight (8) rapid antigen single-test kits or four (4) rapid antigen two-test kits per month. The COVID-19 At-Home Test Reimbursement form is 1 page long and contains: The test will be sent to a lab for processing. *The content below is not intended to be a substitute for professional medical advice, diagnosis or treatment. The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. 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. They should check to see which ones are participating. The member's benefit plan determines coverage. Yes. Your employer or health plan will have the best information on how to buy OTC COVID-19 tests that will be covered. Complete this form for each covered member. If you buy a test at an out-of-network provider, your insurance may only cover $12 of the cost, and you'll be responsible for paying the rest. For members with Aetna pharmacy benefits, you can submit a claim for reimbursement through your Aetna member website. 12/03/2021 05:02 PM EST. 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. It doesnt need a doctors order. Yes, Aetna will cover tests approved, cleared or authorized by the U.S. Food and Drug Administration. 2Disclaimer: Regulations regarding testing for Aetna Medicaid members vary by state and, in some cases, may change in light of the current situation. 1-800-557-6059 | TTY 711, 24/7. If you are not on UHART's . Links to various non-Aetna sites are provided for your convenience only. Get the latest updates on every aspect of the pandemic. 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. Please refer to the FDA and CDC websites for the most up-to-date information. This information is neither an offer of coverage nor medical advice. Yes. For more information about the virus, please visit the CDC and/or WHO websites dedicated to this issue. This information is available on the HRSA website. Now, however, anyone in the U.S. can order a total of four free tests per household via COVIDtests.gov. 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 site said more information on how members can submit claims will soon be available. Postal Service. 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 note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. Learn more here. During the COVID-19 PHE, get one lab-performed test without a health care professional's order, at no cost. 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. COVID-19 Testing, Treatment, Coding & Reimbursement. LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. They may also order up to two sets of four at-home tests per household by visiting COVIDtests.gov. Rates may vary for Commercial Plans based on factors such as billed charges or contractual terms. Tests must be FDA-authorized. This also applies to Medicare and Medicaid plan coverage. The first is to pick them up at a pharmacy or store that your plan designates as "in-network.". Tests must be FDA authorized in accordance with the requirements of the CARES Act. The following are some of the national labs approved to do COVID-19 testing(other commercial labs are also approved): There are other participating commercial labs, hospitals and urgent care centers authorized to provide COVID-19 lab testing. Care providers are responsible for submitting accurate claims in accordance with state and federal laws and UnitedHealthcare's reimbursement policies. 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. At this time, covered tests are not subject to frequency limitations. TTY users can call 1-877-486-2048. You can find a partial list of participating pharmacies at Medicare.gov. Others have four tiers, three tiers or two tiers. Patrick T. Fallon/AFP/Getty Images via Bloomberg. However, you will likely be asked to scan a copy of . Home test kits may be eligible for reimbursement through OptumRx if the test was purchased after January 15, 2022. Important: Use your Aetna ID that starts with a "W.". You are now being directed to the CVS Health site. 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 . 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. If you dont see your patient coverage question here, let us know. 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. 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. Insurance companies are still figuring out the best system to do . Yes, Aetna will cover tests approved, cleared or authorized by the U.S. Food and Drug Administration. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. Last update: February 1, 2023, 4:30 p.m. CT. In that case, you should be able to fill out the form and submit it on the insurance copmany's website, without printing out a physical copy. Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. Sign in or register at Caremark.com (You must be a CVS Caremark member) 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. This search will use the five-tier subtype. 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. Disclaimer of Warranties and Liabilities. The CDC recommends that anyone: who has symptoms of COVID-19 who has been in close contact with a person known to have COVID-19: or who lives in or has recently traveled from an area with ongoing spread of COVID-19, should contact their health care provider and be tested. Your employer or health plan will have the best information on how to buy OTC COVID-19 tests that will be covered. The requirement also applies to self-insured plans. Under the federal governments current guidelines, tests are eligible if: Eligible tests include single-use, cartridge-based tests (for example, Flowflex, BinaxNow or Ongo). 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. If this happens, you can pay for the test, then submit a request for reimbursement. This waiver may remain in place in states where mandated. This waiver may remain in place in states where mandated. 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. This information is available on the HRSA website. 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. 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. A BinaxNow test shows a negative result for COVID-19. Subject to applicable law, Aetna may deny tests that do not meet medical necessity criteria. Tests must be approved, cleared or authorized by the. You can only get reimbursed for tests purchased on January 15, 2022 or later. 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. The requirement also applies to self-insured plans. 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. This includes those enrolled in a Medicare Advantage plan. Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept". 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. All Rights Reserved. This member cost-sharing waiver applies to all Commercial, Medicare and Medicaid lines of business. Who the tests are for (self or dependent), Your pharmacy plan should be able to provide that information. If you suspect price gouging or a scam, contact your state . 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. Do you want to continue? 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). Note: Each test is counted separately even if multiple tests are sold in a single package. Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. Download the form below and mail to: Aetna, P.O. Refer to the U.S. Food & Drug Administration on tests that are eligible for coverage. Medical Reimbursement: COVID Over-the-Counter Test Form (PDF) . Our ability to coordinate the availability of COVID-19 testing bolsters states efforts to manage the spread of the virus. On average this form takes 13 minutes to complete. These forms are usually returned by mail, and you'll most likely find the address for where to mail it on the form itself. Note: Each test is counted separately even if multiple tests are sold in a single package. You wont be able to get reimbursed for tests* that: * May be subject to state-specific COVID-19 coverage mandates. Postal Service will ship the tests directly to your door free of charge. (Offer to transfer member to their PBMs customer service team.). Testing will not be available at all CVS Pharmacy locations. Description. Cigna. Tests must be FDA authorized in accordance with the requirements of the CARES Act. 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. New and revised codes are added to the CPBs as they are updated. The reality may be far different, adding hurdles for . 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. That's beginning to change, however. CPT is a registered trademark of the American Medical Association. Applicable FARS/DFARS apply. Coverage is in effect, per the mandate, until the end of the federal public health emergency. 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. 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. Refer to the CDC website for the most recent guidance on antibody testing. While the Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. 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).