Some pharmacies may not be able to process claims for OTC COVID-19 tests at the pharmacy counter. Refer to the U.S. Food & Drug Administration on tests that are eligible for coverage. Our ability to coordinate the availability of COVID-19 testing bolsters states efforts to manage the spread of the virus. 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. Aetna is working to protect you from COVID-19 scams. The reality may be far different, adding hurdles for . 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. Links to various non-Aetna sites are provided for your convenience only. Box 981106, El Paso, TX 79998-1106. 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. 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. 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 . 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. 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. This mandate is in effect until the end of the federal public health emergency. Members must get them from participating pharmacies and health care providers. Aetna Medicare plans do not reimburse for OTC COVID-19 tests. It doesnt need a doctors order. Cigna. 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. For CVS Health testing initiatives, see section titled, COVID-19 drive-thru testing at CVS Pharmacy locations. No fee schedules, basic unit, relative values or related listings are included in CPT. COVID-19 Testing, Treatment, Coding & Reimbursement. Please log in to your secure account to get what you need. The requirement also applies to self-insured plans. Yes, Aetna will cover tests approved, cleared or authorized by the U.S. Food and Drug Administration. 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 . 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. On average, the test results are typically available within 1-2 days, but may take longer due to local surges in COVID-19. 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. 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. 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. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. This also applies to Medicare and Medicaid plan coverage. Please note that copays, deductibles and coinsurance will apply according to the members benefit plan. 4. 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. During the COVID-19 PHE, get one lab-performed test without a health care professional's order, at no cost. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. 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. 50 (218) 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 Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. Please refer to the FDA and CDC websites for the most up-to-date information. 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 . 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. 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. For more information on what tests are eligible for reimbursement, visit OptumRx's website. Disclaimer of Warranties and Liabilities. In April, CVS Health joined forces with the U. S. Department of Health and Human Services and state governments in Connecticut, Georgia, Massachusetts, Michigan and Rhode Island to help increase access to rapid COVID-19 testing at large-scale sites in publicly accessible areas. 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. It is only a partial, general description of plan or program benefits and does not constitute a contract. 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. 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. 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. 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. Links to various non-Aetna sites are provided for your convenience only. On March 16, the CMS released details about how COVID-19 testing would be reimbursed to health care providers administering the tests. Insurance companies are still figuring out the best system to do . 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. Any test ordered by your physician is covered by your insurance plan. CVS Health currently has more than 4,800 locations across the country offering COVID-19 testing. TTY users can call 1-877-486-2048. As for the eight-test maximum, a family of four covered under the same plan could be reimbursed for up to 32 tests per 30-day period. In addition, Aetna is waiving member cost-sharing for diagnostic testing related to COVID-19. In addition, health insurers now provide or reimburse the cost of up to eight home tests per month for most . Medicare covered OTC COVID tests are provided by participating providers and pharmacies. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. 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 . U0002. 5. Unlisted, unspecified and nonspecific codes should be avoided. 8/31/2021. 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. HCPCS code. Save your COVID-19 test purchase receipts. 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. Rates may vary for Commercial Plans based on factors such as billed charges or contractual terms. Learn whats covered and the steps to get reimbursed. 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. 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. 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. *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. 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. Access trusted resources about COVID-19, including vaccine updates. If you suspect price gouging or a scam, contact your state . Go to the pharmacy website or call the relevant pharmacy to confirm participating locations and get details on how to order. Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept". Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. Health benefits and health insurance plans contain exclusions and limitations. The member's benefit plan determines coverage. Each main plan type has more than one subtype. 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. For more information on test site locations in a specific state, please visit CVS.com. The cost-sharing waiver applies to testing performed or ordered by in-network or out-of-network providers. The AMA is a third party beneficiary to this Agreement. The HRSA COVID-19 Uninsured Program is a claims reimbursement program for health care providers which does not meet the definition of a "health plan" as defined in section 1171(5) of the Social Security Act and in 45 C.F.R. At-home COVID-19 tests are excluded from all coupon discounts and promotions, including CarePass and ExtraBucks Rewards . 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. Lab-based PCR home collection kits are not covered at this time by the OTC kit mandate. Home Test Kit Reimbursement. 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. (For example, BinaxNOW offers a package with two tests included that would count as two individual tests). CPT only copyright 2015 American Medical Association. This member cost-sharing waiver applies to all Commercial, Medicare and Medicaid lines of business. 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. Aetna updated its website Friday with new frequently asked questions about the new requirement. Aetna participating providers should not bill members for Enhanced Infection Control and/or PPE. They should check to see which ones are participating. Please visit your local CVS Pharmacy or request . 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. Lab-based PCR home collection kits are not covered at this time by the OTC kit mandate. Yes. Others have four tiers, three tiers or two tiers. 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. Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search. CPT is a registered trademark of the American Medical Association. 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. 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. 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. 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. Patients will need to pre-register, provide their insurance information as appropriate and verify their eligibility for testing. 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. 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 . The member's benefit plan determines coverage. If you are not on UHART's . This search will use the five-tier subtype. The site said more information on how members can submit claims will soon be available. 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. Members should take their red, white and blue Medicare card when they pick up tests. Claims for reimbursement for at home COVID-19 tests may be submitted online or via mail using the printable form. Tests must be approved, cleared or authorized by the. 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.
