COVID-19 Patient Coverage FAQs for Aetna Providers For members with Aetna pharmacy benefits, you can submit a claim for reimbursement through your Aetna member website. While Clinical Policy Bulletins (CPBs) define Aetna's clinical policy, medical necessity determinations in connection with coverage decisions are made on a case by case basis. You should expect a response within 30 days. Participating pharmacies COVID-19 OTC tests| Medicare.gov Laboratories using the test developed by the Center for Disease Control and Prevention (CDC) would be reimbursed $36 per test. 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. The claim must include an itemized purchase receipt and the COVID-19 test's QR or UPC code, cut out of . Members will need to submit a claim for reimbursement through the Aetna website and will receive a check once the claim is approved. While Clinical Policy Bulletins (CPBs) define Aetna's clinical policy, medical necessity determinations in connection with coverage decisions are made on a case by case basis. 3Rates above are not applicable to Aetna Better Health Plans. 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. While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. 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. You can find a partial list of participating pharmacies at Medicare.gov. When billing, you must use the most appropriate code as of the effective date of the submission. 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. (Offer to transfer member to their PBMs customer service team.). 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 . Access trusted resources about COVID-19, including vaccine updates. 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. For the time being, you'll have to submit a claim to get reimbursed after you buy tests. 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. For more information about the virus, please visit the CDC and/or WHO websites dedicated to this issue. 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. Note: Each test is counted separately even if multiple tests are sold in a single package. For language services, please call the number on your member ID card and request an operator. Use Fill to complete blank online OTHERS pdf forms for free. Get a COVID-19 vaccine as soon as you can. 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. COVID-19 FAQs for Providers | Aetna Medicaid Maryland For more information on what tests are eligible for reimbursement, visit OptumRx's website. CPT is a registered trademark of the American Medical Association. Aetna has reached these conclusions based upon a review of currently available clinical information (including clinical outcome studies in the peer-reviewed published medical literature, regulatory status of the technology, evidence-based guidelines of public health and health research agencies, evidence-based guidelines and positions of leading national health professional organizations, views of physicians practicing in relevant clinical areas, and other relevant factors). 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) 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: Coronavirus (COVID-19) resources | Aetna Medicaid Illinois The tests were shipped through the U.S. Medicare covers one of these PCR kits per year at $0. 12/03/2021 05:02 PM EST. Tests used for employment, school or recreational purposes are not eligible for reimbursement unless required by state law. Please be sure to add a 1 before your mobile number, ex: 19876543210. Aetna makes no representations and accepts no liability with respect to the content of any external information cited or relied upon in the Clinical Policy Bulletins (CPBs). 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. 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 billing, you must use the most appropriate code as of the effective date of the submission. 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. Yes. 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. Important: Use your Aetna ID that starts with a "W.". 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. How to Submit Your At-Home COVID Test to Your Insurance - Health 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. Tests must be used to diagnose a potential COVID-19 infection. You can submit up to 8 tests per covered member per month. Will Medicare cover the cost of at-home COVID tests? Some subtypes have five tiers of coverage. FAQs for COVID-19 Claims Reimbursement to Health Care Providers and Yes. COVID-19 Patient Coverage FAQs for Aetna Providers Yes. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. HCPCS U0003: $100 per test (Commercial plans only), HCPCS U0003: $75 per test (Medicare plans only), HCPCS U0004: $100 per test (Commercial plans only), HCPCS U0004: $75 per test (Medicare plans only), HCPCS U0005: $25 per test (Medicare plans only)*. How to get reimbursed for at-home COVID tests | KTLA Aetna makes no representations and accepts no liability with respect to the content of any external information cited or relied upon in the Clinical Policy Bulletins (CPBs). A BinaxNow test shows a negative result for COVID-19. 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. If your pharmacy benefits are not with Aetna, contact your pharmacy benefits administrator for instructions. 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. If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. The specimen should be sent to these laboratories using standard procedures. Others have four tiers, three tiers or two tiers. The over-the-counter COVID-19 tests will be covered at a reimbursement rate of up to $12 per test, with a quantity limit of eight tests per covered individual every 30 days for test kits obtained . How will I be reimbursed for rapid COVID tests? And other FAQs Get PCR tests and antigen tests through a lab at no cost when a doctor or other health care professional orders it for you. 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. At-Home COVID-19 Self-Test Coverage & FAQs for Members - Aetna Lab-based PCR home collection kits are not covered at this time by the OTC kit mandate. 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. As the insurer Aetna says . Pharmacists, in partnership with other health care providers, are well positioned to aid COVID-19 testing expansion. 5. Want to get your at-home COVID test reimbursed? | kare11.com Coronavirus Test Coverage - Medicare A list of approved tests is available from the U.S. Food & Drug Administration. CPT is a registered trademark of the American Medical Association. 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. Box 981106, El Paso, TX 79998-1106. Refer to the CDC website for the most recent guidance on antibody testing. Patrick T. Fallon/AFP/Getty Images via Bloomberg. CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. This waiver may remain in place in states where mandated. 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. In Vitro Diagnostics EUAs - Antigen Diagnostic Tests for SARS-CoV-2 . Disclaimer of Warranties and Liabilities. 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 updated vaccine targets the original COVID-19 viral strain and 2 Omicron variants (BA.4/BA.5). All claims received for Aetna-insured members going forward will be processed based on this new policy. 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. The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Please visit your local CVS Pharmacy or request . Cue COVID-19 Test for home and over-the-counter (OTC) use. Boxes of iHealth COVID-19 rapid test kits. Aetna updated its website Friday with new frequently asked questions about the new requirement. Please note that copays, deductibles and coinsurance will apply according to the members benefit plan. 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. If a member is billed for Enhanced Infection Control and/or PPE by a participating provider, he/she should contact Aetna customer service at the phone number listed on the members ID card. The information you will be accessing is provided by another organization or vendor. You are not eligible if you have Medicare, Medicare Supplement, Medicaid, or voluntary insurance. Claim Coding, Submissions and Reimbursement. Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. The U.S. This includes those enrolled in a Medicare Advantage plan. Aetna will cover treatment of COVID-19 for our Medicare Advantage members. Postal Service will ship the tests directly to your door free of charge. They should check to see which ones are participating. COVID-19 Over-the-Counter Test Reimbursement Form - OptumRx CPT only Copyright 2022 American Medical Association. Any test ordered by your physician is covered by your insurance plan. Download the form below and mail to: Aetna, P.O. Learn more here. Members should take their red, white and blue Medicare card when they pick up their tests. In case of a conflict between your plan documents and this information, the plan documents will govern. COVID-19 Tests Insurance Reimbursement - Amazon.com Coverage is in effect, per the mandate, until the end of the federal public health emergency. 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. 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. 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 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. The health insurance company Aetna has a guide on . Aetna Better Health will cover the treatment of COVID-19 or health complications associated with COVID-19. No. COVID-19 Testing, Treatment, Coding & Reimbursement. In case of a conflict between your plan documents and this information, the plan documents will govern. . No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM. 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. Please log in to your secure account to get what you need. 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. Visit the World Health Organization for global news on COVID-19. The test can be done by any authorized testing facility. You are now being directed to the CVS Health site. 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. Treating providers are solely responsible for medical advice and treatment of members. 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 . Why Getting Reimbursed for Covid Tests Is a Pain in the Ass - Vice If you have health coverage through Cigna, you will need to print and fill out this at-home COVID-19 test reimbursement form. Yes. 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. 2Disclaimer: Regulations regarding testing for Aetna Medicaid members vary by state and, in some cases, may change in light of the current situation. Home test kits may be eligible for reimbursement through OptumRx if the test was purchased after January 15, 2022. 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. The CDC recommends that anyone: who has symptoms of COVID-19 who has been in close contact with a person known to have COVID-19: or who lives in or has recently traveled from an area with ongoing spread of COVID-19, should contact their health care provider and be tested. *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. Tests must be used to diagnose a potential COVID-19 infection. For all Aetna-insured Commercial plans, Aetna waived member cost-sharing for inpatient admissions for treatment of COVID-19 or health complications associated with COVID-19 through February 28, 2021. Applicable FARS/DFARS apply. Aetna generally does not reimburse doctors and dentists for Personal Protection Equipment. No fee schedules, basic unit, relative values or related listings are included in CPT. 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. $51.33. Aetna is working to protect you from COVID-19 scams. 8/31/2021. COVID-19 Testing and Treatment | Student Health Benefits COVID-19: Billing & Coding FAQs for Aetna Providers Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search. 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. 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. 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. Links to various non-Aetna sites are provided for your convenience only. No fee schedules, basic unit, relative values or related listings are included in CPT. Biden-Harris Administration Requires Insurance Companies and Group
