reimbursement scheme relies on people being able to find rapid COVID tests to buy either online or at their local pharmacy. Medicare now covers up to 8 over-the-counter COVID-19 tests each calendar month, at no cost to you. Patients will need to pre-register, provide their insurance information as appropriate and verify their eligibility for testing. Members should take their red, white and blue Medicare card when they pick up their tests. Aetna generally does not reimburse doctors and dentists for Personal Protection Equipment. 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. To make sure I didn't have COVID, I purchased a COVID test kit from Walgreens . The information you will be accessing is provided by another organization or vendor. Yes. 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. Aetna updated its website Friday with new frequently asked questions about the new requirement. This Agreement will terminate upon notice if you violate its terms. 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. . Reimbursement. To ensure access for COVID-19 testing and have consistent reimbursement, Aetnawill reimburse contracted and non-contracted providers for COVID-19 testing as follows in accordance with the members benefit plan3. Please report any scams by calling 1-800-447-8477 or online at https://tips.oig.hhs.gov/. Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. Providers will bill Medicare. You are now being directed to CVS Caremark site. If you are still covered by a qualifying high-deductible health plan, you can continue to contribute as well. This mandate is in effect until the end of the federal public health emergency. If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. 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. You can find a partial list of participating pharmacies at Medicare.gov. Go to the American Medical Association Web site. In addition, Aetna is waiving member cost-sharing for diagnostic testing related to COVID-19. 5. Self-insured plan sponsors offered this waiver at their discretion. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Yes, Aetna will cover tests approved, cleared or authorized by the U.S. Food and Drug Administration. Any test ordered by your physician is covered by your insurance plan. Get the latest updates on every aspect of the pandemic. You are not eligible if you have Medicare, Medicare Supplement, Medicaid, or voluntary insurance. 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. 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. 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. Once they have registered, the patient will be provided with an appointment window for up to seven days in advance. For language services, please call the number on your member ID card and request an operator. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. 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. Providers can seek reimbursement for uninsured patients through the Health Resources & Services Administration (HRSA) for COVID-19 testing, treatment and vaccine administration. Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". No, Aetna will pay the amount of the cost-sharing the member would have ordinarily paid so the provider would receive the same total payment. Disclaimer of Warranties and Liabilities. If your reimbursement request is approved, a check will be mailed to you. A BinaxNow test shows a negative result for COVID-19. No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM. You can use this money to pay for HSA eligible products. Please refer to the FDA and CDC websites for the most up-to-date information. The Biden administration will launch a website where Americans can order free coronavirus tests on Jan. 19.. Aetna Better Health plan pricing may be determined by each individual health plan in accordance with its state contracts. If this happens, you can pay for the test, then submit a request for reimbursement. . 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. Aetna Better Health will cover the treatment of COVID-19 or health complications associated with COVID-19. At this time, covered tests are not subject to frequency limitations. 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. 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. 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 this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. This requirement will continue as long as the COVID public health emergency lasts. Access trusted resources about COVID-19, including vaccine updates. Please note also that the ABA Medical Necessity Guidemay be updated and are, therefore, subject to change. At this time, covered tests are not subject to frequency limitations. These reimbursement rates for COVID-19 diagnostic and antibody testing are based on rates announced by CMS. 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 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. They may also order up to two sets of four at-home tests per household by visiting COVIDtests.gov. LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). OTC COVID-19 tests can be purchased at pharmacies, retail locations or online. 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 . Your pharmacy plan should be able to provide that information. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. Do not respond if you get a call, text or email about "free" coronavirus testing. Subject to applicable law, Aetna may deny tests that do not meet medical necessity criteria. 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. Aetna Medicare members can obtain OTC COVID-19 tests from participating providers and pharmacies, but will not be reimbursed for self-purchased tests. The test will be sent to a lab for processing. New and revised codes are added to the CPBs as they are updated. 2Disclaimer: Regulations regarding testing for Aetna Medicaid members vary by state and, in some cases, may change in light of the current situation. Stay up to date and find state resources, like testing sites, updated case counts, facts from the Centers for Disease Control and more. 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. 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. $35.92. Starting Saturday, private health plans are required to cover . You can continue to use your HSA even if you lose your job. Please note also that Dental Clinical Policy Bulletins (DCPBs) are regularly updated and are therefore subject to change. 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. The reality may be far different, adding hurdles for . 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. Any test ordered by your physician is covered by your insurance plan. Patrick T. Fallon/AFP/Getty Images via Bloomberg. Please note also that the ABA Medical Necessity Guidemay be updated and are, therefore, subject to change. CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. 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 must be approved, cleared or authorized by the. 3Rates above are not applicable to Aetna Better Health Plans. Thanks! And other FAQs. 1-800-557-6059 | TTY 711, 24/7. Treating providers are solely responsible for medical advice and treatment of members. CPT is a registered trademark of the American Medical Association. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Call 1-800-Medicare (1-800-633-4227) with any questions about this initiative. All Rights Reserved. Print the form and fill it out completely. Tests used for employment, school or recreational purposes are not eligible for reimbursement unless required by state law. Treating providers are solely responsible for medical advice and treatment of members. This includes those enrolled in a Medicare Advantage plan. No fee schedules, basic unit, relative values or related listings are included in CPT. Links to various non-Aetna sites are provided for your convenience only. Home test kits may be eligible for reimbursement through OptumRx if the test was purchased after January 15, 2022. The test can be done by any authorized testing facility. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. 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 . Cigna. The member's benefit plan determines coverage. You can only get reimbursed for tests purchased on January 15, 2022 or later. Once completed you can sign your fillable form or send for signing. CPT only copyright 2015 American Medical Association. The new states are Alabama, Arkansas, Colorado, Delaware, Iowa, Mississippi, Montana, North Dakota, Oregon and West Virginia. You can also use it to pay for medical, dental and vision bills, including telehealth and COVID-19 treatment. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Unlisted, unspecified and nonspecific codes should be avoided. Download the form below and mail to: Aetna, P.O. Unlisted, unspecified and nonspecific codes should be avoided. Your benefits plan determines coverage. Claim Coding, Submissions and Reimbursement. Please note: Your receipt must be dated January 15, 2022 or later to be eligible for reimbursement. CPT only copyright 2015 American Medical Association. The specimen should be sent to these laboratories using standard procedures. If you have private, employer-sponsored or student health commercial insurance youre eligible to get reimbursed for over-the-counter at-home COVID kits. 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 information contained in this FAQ is subject to change at the discretion of CVS at any time, for any reason and without advanced notice. This mandate is in effect until the end of the federal public health emergency. . 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 .