If you dont see your patient coverage question here, let us know. You can only get reimbursed for tests purchased on January 15, 2022 or later. Reimbursement for 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV testing using any technique multiple types, subtypes (includes all targets) Reimbursement. Print the form and fill it out completely. . The following rates are used for COVID-19 testing for commercial and Medicare plans, unless noted otherwise: Diagnostic testing/handling rates - Medicare. Links to various non-Aetna sites are provided for your convenience only. 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. 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. 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 . Refer to the CDC website for the most recent guidance on antibody testing. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. 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. 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. Home Test Kit Reimbursement. 4. Disclaimer of Warranties and Liabilities. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. Health benefits and health insurance plans contain exclusions and limitations. 1Aetna will follow all federal and state mandates for insured plans, as required. The member's benefit plan determines coverage. 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 . 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. Coverage is in effect, per the mandate, until the end of the federal public health emergency. Our ability to coordinate the availability of COVID-19 testing bolsters states efforts to manage the spread of the virus. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Aetna will cover, without cost share, serological (antibody) tests that are ordered by a physician or authorized health care professional and are medically necessary. Last update: February 1, 2023, 4:30 p.m. CT. All forms are printable and downloadable. Others have four tiers, three tiers or two tiers. Some subtypes have five tiers of coverage. Subject to applicable law, Aetna may deny tests that do not meet medical necessity criteria. CPT is a registered trademark of the American Medical Association. You can find a partial list of participating pharmacies at Medicare.gov. 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. 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 are now being directed to CVS caremark site. Do you want to continue? For more information on test site locations in a specific state, please visit CVS.com. Providers will bill Medicare. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. 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. You are now being directed to the CVS Health site. Learn more here. Do you want to continue? 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. For more information and future updates, visit the CMS website and its newsroom. 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. You can also call Aetna Member Services by . Reprinted with permission. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. 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. The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. 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 . 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. 2020 claims eligible for the 20% increase in the MS-DRG weighting factor will also be required to have a . Get the latest updates on every aspect of the pandemic. This information is neither an offer of coverage nor medical advice. Please note that copays, deductibles and coinsurance will apply according to the members benefit plan. 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. CPT only Copyright 2022 American Medical Association. Of note: Aetna specifies that "tests must be used to diagnose a potential Covid-19 infection" and tests used for employment, school or recreational purposes aren't eligible for reimbursement. Self-insured plan sponsors offered this waiver at their discretion. Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. As omicron has soared, the tests' availability seems to have plummeted. The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. 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. 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. 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. Send it to the address shown on the form. 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. The responsibility for the content of Aetna Precertification Code Search Tool is with Aetna and no endorsement by the AMA is intended or should be implied. Self-insured plan sponsors offered this waiver at their discretion. Since January 2022, health insurance plans have been required to cover the cost of at-home rapid tests for COVID-19. This mandate is in effect until the end of the federal public health emergency. PPE, like other disposable infection control supplies, is part of the cost of the underlying procedure. No fee schedules, basic unit, relative values or related listings are included in CPT. Detect Covid-19 test. Be sure to check your email for periodic updates. Treating providers are solely responsible for medical advice and treatment of members. Lab-based PCR home collection kits are not covered at this time by the OTC kit mandate. The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. In addition, coverage may be mandated by applicable legal requirements of a State or the Federal government. Yes, patients must register in advance at CVS.comto schedule an appointment. 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. 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. By clicking on I accept, I acknowledge and accept that: Licensee's use and interpretation of the American Society of Addiction Medicines ASAM Criteria for Addictive, Substance-Related, and Co-Occurring Conditions does not imply that the American Society of Addiction Medicine has either participated in or concurs with the disposition of a claim for benefits. The cost-sharing waiver applies to testing performed or ordered by in-network or out-of-network providers. For example, Binax offers a package with two tests that would count as two individual tests. The new states are Alabama, Arkansas, Colorado, Delaware, Iowa, Mississippi, Montana, North Dakota, Oregon and West Virginia. Yes, patients must register in advance at CVS.com to schedule an appointment. CPT only copyright 2015 American Medical Association. You can also use it to pay for medical, dental and vision bills, including telehealth and COVID-19 treatment. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Aetna will cover treatment of COVID-19 for our Medicare Advantage members. However, you will likely be asked to scan a copy of . Aetna is in the process of developing a direct-to-consumer shipping option. You may opt out at any time. These forms are usually returned by mail, and you'll most likely find the address for where to mail it on the form itself. Go to the American Medical Association Web site. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. 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 example, Binax offers a package with two tests that would count as two individual tests. Treating providers are solely responsible for medical advice and treatment of members. 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. The site said more information on how members can submit claims will soon be available. Members must get them from participating pharmacies and health care providers. 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. This mandate is in effect until the end of the federal public health emergency. 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. CPT is a registered trademark of the American Medical Association. All claims received for Aetna-insured members going forward will be processed based on this new policy. Your pharmacy plan should be able to provide that information. 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. Please refer to the FDA and CDC websites for the most up-to-date information. . Using FSA or HSA Funds. Commercial labs are in the process of updating their provider community about their capabilities and how to order tests. This includes those enrolled in a Medicare Advantage plan. Visit the World Health Organization for global news on COVID-19.