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. The member's benefit plan determines coverage. *As announced by CMS, starting January 1, 2021, Medicare will make an additional $25 add-on payment to laboratories for a COVID-19 diagnostic test run on high throughput technology if the laboratory: a) completes the test in two calendar days or less, and b) completes the majority of their COVID-19 diagnostic tests that use high throughput technology in two calendar days or less for all of their patients (not just their Medicare patients) in the previous month. 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 . A list of approved tests is available from the U.S. Food & Drug Administration. 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). . Claim Coding, Submissions and Reimbursement. Yes. 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. The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. 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. 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. 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. Health benefits and health insurance plans contain exclusions and limitations. 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 submit up to 8 tests per covered member per month. 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: No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. The free at-home COVID-19 test program ran from January 19, 2022 to September 2, 2022. You can find a partial list of participating pharmacies at Medicare.gov. If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. Aetna updated its website Friday with new frequently asked questions about the new requirement. Please be sure to add a 1 before your mobile number, ex: 19876543210. Unlisted, unspecified and nonspecific codes should be avoided. This waiver may remain in place in states where mandated. Aetna Medicaid Illinois is here for you during the coronavirus (COVID-19) pandemic, no matter what. There are two main ways to purchase these tests. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. Aetna Medicare plans do not reimburse for OTC COVID-19 tests. 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. In addition, Aetna is waiving member cost-sharing for diagnostic testing related to COVID-19. 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. Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. . Go to the American Medical Association Web site. In addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members. This includes the testing only not necessarily the Physician visit. 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. At this time, covered tests are not subject to frequency limitations. Each site operated seven days a week, providing results to patients on-site, through the end of June. Aetna's 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). Disclaimer of Warranties and Liabilities. This requirement will continue as long as the COVID public health emergency lasts. If a member is billed for Enhanced Infection Control and/or PPE by a participating provider, he/she should contact Aetna customer service at the phone number listed on the members ID card. Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. Pharmacists, in partnership with other health care providers, are well positioned to aid COVID-19 testing expansion. Please log in to your secure account to get what you need. This allows us to continue to help slow the spread of the virus. Providers are encouraged to call their provider services representative for additional information. Members should discuss any Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider. 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. Refer to the U.S. Food & Drug Administration on tests that are eligible for coverage. Providers will bill Medicare. You are now being directed to CVS caremark site. Please refer to the FDA and CDC websites for the most up-to-date information. Please note: Your receipt must be dated January 15, 2022 or later to be eligible for reimbursement. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. All Rights Reserved. If you have private, employer-sponsored or student health commercial insurance youre eligible to get reimbursed for over-the-counter at-home COVID kits. You are not eligible if you have Medicare, Medicare Supplement, Medicaid, or voluntary insurance. The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. 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. CVS Health currently has more than 4,800 drive thru testing locations across the country offering COVID-19 testing. Claims for reimbursement for at home COVID-19 tests may be submitted online or via mail using the printable form. If your pharmacy benefits are not with Aetna, contact your pharmacy benefits administrator for instructions. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. For example, Binax offers a package with two tests that would count as two individual tests. Using FSA or HSA Funds. 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. You can only get reimbursed for tests purchased on January 15, 2022 or later. 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. 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. 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. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. During the COVID-19 PHE, get one lab-performed test without a health care professional's order, at no cost. The following rates are used for COVID-19 testing for commercial and Medicare plans, unless noted otherwise: Diagnostic testing/handling rates - Medicare. Learn whats covered and the steps to get reimbursed. Complete this form for each covered member. 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. 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 participating providers should not bill members for Enhanced Infection Control and/or PPE. The claim must include an itemized purchase receipt and the COVID-19 test's QR or UPC code, cut out of . 50 (218) 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. This information helps us provide information tailored to your Medicare eligibility, which is based on age. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements. Aetna 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). 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. Coverage is available for members eligible with Medicare Part B FFS or Medicare Advantage Benefits. 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. Once completed you can sign your fillable form or send for signing. Get PCR tests and antigen tests through a lab at no cost when a doctor or other health care professional orders it for you. 5. Effective April 4, 2022, Medicare will cover up to eight (8) at-home COVID-19 tests per person every 30 days or four (4) two-test, rapid antigen at-home tests every 30 days without a prescription. 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. 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. Click on the COVID-19 Home Test Reimbursement Form link. In addition, coverage may be mandated by applicable legal requirements of a State or the Federal government. Some subtypes have five tiers of coverage. The ABA Medical Necessity Guidedoes not constitute medical advice. 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. Blue Shield of California, Care First, Cigna, CVS Group/Aetna, and Kaiser Permanente) are currently relying only on reimbursement . CVS Pharmacy, HealthHUB and MinuteClinic will continue to serve customers and patients. 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. 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. Do not respond if you get a call, text or email about "free" coronavirus testing. Yes. Tests used for employment, school or recreational purposes are not eligible for reimbursement unless required by state law. Providers are encouraged to call their provider services representative for additional information. Any test ordered by your physician is covered by your insurance plan. Note: Each test is counted separately even if multiple tests are sold in a single package. Starting January 15, most people with a health plan can go online, or to a pharmacy or store to purchase an at-home over-the-counter COVID-19 diagnostic test authorized by the U.S. Food and Drug Administration (FDA) at no cost, either through reimbursement or free of charge through their insurance. Call 1-800-Medicare (1-800-633-4227) with any questions about this initiative. 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 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. 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. It doesnt need a doctors order. CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. Members must get them from participating pharmacies and health care providers. The requirement also applies to self-insured plans. 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). For now, the only submission instructions are to fax the completed form to 859-410-2422 or physically mail it along with any receipts to the address on the back of your health insurance card. Tests must be used to diagnose a potential COVID-19 infection. For more information about the virus, please visit the CDC and/or WHO websites dedicated to this issue. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. You can also call Aetna Member Services by . The omicron surge may be receding in Michigan, but more than 13,000 in the state are still testing . Now, however, anyone in the U.S. can order a total of four free tests per household via COVIDtests.gov. Cigna. Each main plan type has more than one subtype. 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. Aetna will cover treatment of COVID-19 for our Medicare Advantage members. Aetna members can now receive reimbursement for test kits purchased on or after Jan. 15, 2022. The new states are Alabama, Arkansas, Colorado, Delaware, Iowa, Mississippi, Montana, North Dakota, Oregon and West Virginia. If your reimbursement request is approved, a check will be mailed to you. This information is neither an offer of coverage nor medical advice. . Last update: February 1, 2023, 4:30 p.m. CT. 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. 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. Links to various non-Aetna sites are provided for your convenience only. 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.