The COVID-19 At-Home Test Reimbursement form is 1 page long and contains: Treating providers are solely responsible for medical advice and treatment of members. 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. 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. The requirement also applies to self-insured plans. Starting Saturday, private health plans are required to cover . Yes, Aetna will cover tests approved, cleared or authorized by the U.S. Food and Drug Administration. 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. Patrick T. Fallon/AFP/Getty Images via Bloomberg. CPT only copyright 2015 American Medical Association. This policy for diagnostic and antibody testing applies to Commercial, Medicare and Medicaid plans.2. License to sue 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. 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. The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. $35.92. The tests were shipped through the U.S. The AMA is a third party beneficiary to this Agreement. The member's benefit plan determines coverage. Members must get them from participating pharmacies and health care providers. Yes, Aetna will cover tests approved, cleared or authorized by the U.S. Food and Drug Administration. Your employer or health plan will have the best information on how to buy OTC COVID-19 tests that will be covered. Applicable FARS/DFARS apply. 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. Description. 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. Reimbursement for 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV testing using any technique multiple types, subtypes (includes all targets) Reimbursement. When billing, you must use the most appropriate code as of the effective date of the submission. 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 . Some plans exclude coverage for services or supplies that Aetna considers medically necessary. 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. 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. the labs to efficiently report and track testing services related to SARS-CoV-2 and will streamline the reporting and reimbursement for this test in the US. These forms are usually returned by mail, and you'll most likely find the address for where to mail it on the form itself. Those using a non-CDC test will be reimbursed $51 . The following rates are used for COVID-19 testing for commercial and Medicare plans, unless noted otherwise: Diagnostic testing/handling rates - Medicare. Please note also that the ABA Medical Necessity Guidemay be updated and are, therefore, subject to change. Home test kits may be eligible for reimbursement through OptumRx if the test was purchased after January 15, 2022. 50 (218) Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. 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. If you have private, employer-sponsored or student health commercial insurance youre eligible to get reimbursed for over-the-counter at-home COVID kits. Save your COVID-19 test purchase receipts. Medicare covers the updated COVID-19 vaccine at no cost to you. COVID-19 home test kit returns will not be accepted. The Biden Administration announced on December 2, 2021 (followed by detailed guidance released on January 10, 2022) that private insurers would be required to also begin covering the cost of rapid . If you have private, employer-sponsored or student health commercial insurance youre eligible to get reimbursed for over-the-counter at-home COVID kits. 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. Members should discuss any matters related to their coverage or condition with their treating provider. 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. Reimbursement. 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). Tests must be FDA-authorized. If you do not intend to leave our site, close this message. Aetna is in the process of developing a direct-to-consumer shipping option. All Rights Reserved. TTY users can call 1-877-486-2048. This coverage continues until the COVID-19 . Reimbursement for using the CDC 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Panel. The site said more information on how members can submit claims will soon be available. 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. You can also use it to pay for medical, dental and vision bills, including telehealth and COVID-19 treatment. Under the federal governments current guidelines, tests are eligible if: Eligible tests include single-use, cartridge-based tests (for example, Flowflex, BinaxNow or Ongo). At-home COVID-19 tests are excluded from all coupon discounts and promotions, including CarePass and ExtraBucks Rewards . 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. This Agreement will terminate upon notice if you violate its terms. CVS Pharmacy, HealthHUB and MinuteClinic will continue to serve customers and patients. Send it to the address shown on the form. It is only a partial, general description of plan or program benefits and does not constitute a contract. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. When submitting COVID-19-related claims, follow the coding guidelines and guidance outlined below and review the CDC guideline for ICD-10-CM . The policy aligns with Families First and CARES Act legislation and regulations requiring all health plans to provide coverage of COVID-19 testing without cost share. Tests must be FDA authorized in accordance with the requirements of the CARES Act. Aetna is reaching out to the commercial labs about their ability to provide the COVID-19 testing. Each main plan type has more than one subtype. For example, Binax offers a package with two tests that would count as two individual tests. 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. You are now being directed to CVS caremark site. The member's benefit plan determines coverage. The ABA Medical Necessity Guidedoes not constitute medical advice. . Please call your medical benefits administrator for your testing coverage details. As an Aetna member, per the Federal Government, you are eligible for insurance reimbursement under a qualified plan for FDA-authorized COVID-19 at-home tests purchased on or after January 15. However, you will likely be asked to scan a copy of . 7/31/2021. Just enter your mobile number and well text you a link to download the Aetna Health app from the App Store or on Google Play. Please refer to the FDA and CDC websites for the most up-to-date information. ", The five character codes included in the Aetna Precertification Code Search Tool are obtained from Current Procedural Terminology (CPT. Patients will need to pre-register, provide their insurance information as appropriate and verify their eligibility for testing. If this happens, you can pay for the test, then submit a request for reimbursement. This excerpt is provided for use in connection with the review of a claim for benefits and may not be reproduced or used for any other purpose. CPT is a registered trademark of the American Medical Association. 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. Any use of CPT outside of Aetna Precertification Code Search Tool should refer to the most Current Procedural Terminology which contains the complete and most current listing of CPT codes and descriptive terms. While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. Applicable FARS/DFARS apply. Boxes of iHealth COVID-19 rapid test kits. On March 16, the CMS released details about how COVID-19 testing would be reimbursed to health care providers administering the tests. Patients will need to pre-register, provide their insurance information as appropriate and verify their eligibility for testing. CVS Health currently has more than 4,800 drive thru testing locations across the country offering COVID-19 testing. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. You can find a partial list of participating pharmacies at Medicare.gov. Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". 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. Laboratories that complete a majority of COVID-19 diagnostic tests run on high throughput technology within two days will be paid $100 per test by Medicare, while laboratories that take longer will receive $75 per test. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. Your employer or health plan will have the best information on how to buy OTC COVID-19 tests that will be covered. $51.33. 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 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. 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. 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. This benefit does not apply to Aetna Better Heath of New York, since medical benefits are not covered. Our ability to coordinate the availability of COVID-19 testing bolsters states efforts to manage the spread of the virus. This information is neither an offer of coverage nor medical advice. 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). The requirement also applies to self-insured plans. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Refer to the CDC website for the most recent guidance on antibody testing. CVS Health currently has more than 4,800 locations across the country offering COVID-19 testing. 2. Access trusted resources about COVID-19, including vaccine updates. In addition, Aetna is waiving member cost-sharing for diagnostic testing related to COVID-19. The first is to pick them up at a pharmacy or store that your plan designates as "in-network.". Laboratories using the test developed by the Center for Disease Control and Prevention (CDC) would be reimbursed $36 per test. Note: Each test is counted separately even if multiple tests are sold in a single package. Treating providers are solely responsible for medical advice and treatment of members. OTC COVID-19 tests can be purchased at pharmacies, retail locations or online. Recently, the United States government made available four free at-home COVID-19 tests to each home address upon request. This includes those enrolled in a Medicare Advantage plan. Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. For language services, please call the number on your member ID card and request an operator. Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. You can use this money to pay for HSA eligible products. Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept". Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Medicare covered OTC COVID tests are provided by participating providers and pharmacies. . Tests must be purchased on or after January 15, 2022. Please be sure to add a 1 before your mobile number, ex: 19876543210. Some subtypes have five tiers of coverage. (Offer to transfer member to their PBMs customer service team.). Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. This mandate is in effect until the end of the federal public health emergency. COVID-19 testing, vaccines, hospitalizations and related expenses will return to the standard coverage for in-network and out of network services. Providers are encouraged to call their provider services representative for additional information. Please note: Your receipt must be dated January 15, 2022 or later to be eligible for reimbursement. 1-800-557-6059 | TTY 711, 24/7. Medical Reimbursement: COVID Over-the-Counter Test Form (PDF) . 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. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. This page provides MassHealth Coronavirus Disease (COVID-19) guidance and information for all MassHealth providers. The reality may be far different, adding hurdles for . Participating pharmacies offering COVID-19 Over-the-Counter (OTC) tests The following is a partial list of pharmacies participating in the Medicare COVID-19 Over-the-Counter (OTC) tests initiative. LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). If you do not intend to leave our site, close this message. Do not respond if you get a call, text or email about "free" coronavirus testing. 5. 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. 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. 8/31/2021. You may opt out at any time. Beginning in September 2021, we have added a select number of new testing locations in 10 new states to increase access to COVID-19 testing in high-risk, underserved communities with limited availability to lab testing services. Medicare covers the vaccine for anyone who has Medicare due to their age, a disability, End-Stage Renal Disease (ESRD), or ALS (also called . Aetna will cover treatment of COVID-19 for our Medicare Advantage members. Up to eight tests per 30-day period are covered. Aetna Medicare plans do not reimburse for OTC COVID-19 tests. This member cost-sharing waiver applies to all Commercial, Medicare and Medicaid lines of business. 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 policy . Get a COVID-19 vaccine as soon as you can. 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. 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. 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. Each site operated seven days a week, providing results to patients on-site, through the end of June. In case of a conflict between your plan documents and this information, the plan documents will govern. The U.S. Once completed you can sign your fillable form or send for signing. 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. 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. 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.

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