Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. Treating providers are solely responsible for medical advice and treatment of members. These guidelines do not apply to Medicare. The information you will be accessing is provided by another organization or vendor. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. PPE, like other disposable infection control supplies, is part of the cost of the underlying procedure. CPT is a registered trademark of the American Medical Association. 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. Visit the secure website, available through www.aetna.com, for more information. Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. 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. Once they have registered, the patient will be provided with an appointment window for up to seven days in advance. 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. 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. The member's benefit plan determines coverage. Aetna will cover treatment of COVID-19 for our Medicare Advantage members. 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. Laboratories using the test developed by the Center for Disease Control and Prevention (CDC) would be reimbursed $36 per test. 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. Aetna complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, creed, religious ailiation, ancestry, sex gender . Last update: February 1, 2023, 4:30 p.m. CT. $51.33. Now, however, anyone in the U.S. can order a total of four free tests per household via COVIDtests.gov. This does not apply to Medicare. 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. Yes. Please log in to your secure account to get what you need. 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. Links to various non-Aetna sites are provided for your convenience only. 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. (For example, BinaxNOW offers a package with two tests included that would count as two individual tests). 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. Refer to the U.S. Food & Drug Administration on tests that are eligible for coverage. Those who have already purchased . 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. You can find a partial list of participating pharmacies at Medicare.gov. 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. Care providers are responsible for submitting accurate claims in accordance with state and federal laws and UnitedHealthcare's reimbursement policies. Medicare covered OTC COVID tests are provided by participating providers and pharmacies. The tests were shipped through the U.S. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. Since Clinical Policy Bulletins (CPBs) can be highly technical and are designed to be used by our professional staff in making clinical determinations in connection with coverage decisions, members should review these Bulletins with their providers so they may fully understand our policies. Our pharmacies and MinuteClinics are uniquely positioned to help address the pandemic and protect peoples health. Providers can seek reimbursement for uninsured patients through the Health Resources & Services Administration (HRSA) for COVID-19 testing, treatment and vaccine administration. 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 should discuss any matters related to their coverage or condition with their treating provider. Claim Coding, Submissions and Reimbursement. All telehealth/telemedicine, which includes all medical and behavioral health care . 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. These forms are usually returned by mail, and you'll most likely find the address for where to mail it on the form itself. 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. Aetna generally does not reimburse doctors and dentists for Personal Protection Equipment. . For more information about the virus, please visit the CDC and/or WHO websites dedicated to this issue. Providers are encouraged to call their provider services representative for additional information. 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. The test can be done by any authorized testing facility. . 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: Who the tests are for (self or dependent), Your pharmacy plan should be able to provide that information. The U.S. 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. Aetna updated its website Friday with new frequently asked questions about the new requirement. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. 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. Our ability to coordinate the availability of COVID-19 testing bolsters states efforts to manage the spread of the virus. Tests must be purchased on or after January 15, 2022. 4. You are now being directed to the CVS Health site. Any test ordered by your physician is covered by your insurance plan. Save your COVID-19 test purchase receipts. 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). Parents or guardians seeking testing for children under the age of 10 (or the age of 5 for rapid-result testing) should consult with a pediatrician to identify appropriate testing options. 7/31/2021. 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. 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. The AMA is a third party beneficiary to this Agreement. This mandate is in effect until the end of the federal public health emergency. This applies whether you purchased your health . Be sure to check your email for periodic updates. Please log in to your secure account to get what you need. 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. 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. Reprinted with permission. For more information, see the attached Guidance for COVID-19 OTC Testing Coverage. 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. CPT is a registered trademark of the American Medical Association. Tests must be FDA-authorized. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Call 1-800-Medicare (1-800-633-4227) with any questions about this initiative. Send it to the address shown on the form. While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. 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. 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. 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. 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). They may also order up to two sets of four at-home tests per household by visiting COVIDtests.gov. If you have any questions on filling out the form, please call 1-888-238-6240. 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. You should expect a response within 30 days. Any test ordered by your physician is covered by your insurance plan. Testing will not be available at all CVS Pharmacy locations. This mandate is in effect until the end of the federal public health emergency. Aetna Better Health members with questions about these specific benefits are encouraged to call the member services phone number on the back of their ID cards. The term precertification here means the utilization review process to determine whether the requested service, procedure, prescription drug or medical device meets the company's clinical criteria for coverage. (For example, BinaxNOW offers a package with two tests included that would count as two individual tests). No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM. 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. 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. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Print the form and fill it out completely. Others have four tiers, three tiers or two tiers. Please note also that the ABA Medical Necessity Guidemay be updated and are, therefore, subject to change. For language services, please call the number on your member ID card and request an operator. For members with Aetna pharmacy benefits, you can submit a claim for reimbursement through your Aetna member website. Patients will need to pre-register, provide their insurance information as appropriate and verify their eligibility for testing. By submitting a claim to Aetna for COVID-19 testing, providers acknowledge that the above amounts will be accepted as payment in full for each COVID-19 test performed, and that they will not seek additional reimbursement from members. Unlisted, unspecified and nonspecific codes should be avoided. Since Dental Clinical Policy Bulletins (DCPBs) can be highly technical and are designed to be used by our professional staff in making clinical determinations in connection with coverage decisions, members should review these Bulletins with their providers so they may fully understand our policies. The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. 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. You should expect a response within 30 days. Please note that copays, deductibles and coinsurance will apply according to the members benefit plan. On March 16, the CMS released details about how COVID-19 testing would be reimbursed to health care providers administering the tests. Members should take their red, white and blue Medicare card when they pick up their tests. The claim must include an itemized purchase receipt and the COVID-19 test's QR or UPC code, cut out of . Patient samples collected at our COVID-19 drive-thru testing sites are sent offsite to independent, third-party labs who are responsible for processing and delivering the results, which we then communicate to patients. You are not eligible if you have Medicare, Medicare Supplement, Medicaid, or voluntary insurance. Rates may vary for Commercial Plans based on factors such as billed charges or contractual terms. Please note also that the ABA Medical Necessity Guidemay be updated and are, therefore, subject to change. 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. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Aetna is reaching out to the commercial labs about their ability to provide the COVID-19 testing. Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. 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. . For example, Binax offers a package with two tests that would count as two individual tests. Subject to applicable law, Aetna may deny tests that do not meet medical necessity criteria. 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. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. 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 omicron surge may be receding in Michigan, but more than 13,000 in the state are still testing . Coverage is available for members eligible with Medicare Part B FFS or Medicare Advantage Benefits. 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 the insurer Aetna says . Members must get them from participating pharmacies and health care providers. 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. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Please report any scams by calling 1-800-447-8477 or online at https://tips.oig.hhs.gov/. Your pharmacy plan should be able to provide that information. 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. 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. 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.