Treating providers are solely responsible for medical advice and treatment of members. For more information on what tests are eligible for reimbursement, visit OptumRx's website. All Rights Reserved. ", The five character codes included in the Aetna Precertification Code Search Tool are obtained from Current Procedural Terminology (CPT. You can find a partial list of participating pharmacies at Medicare.gov. You wont be able to get reimbursed for tests* that: * May be subject to state-specific COVID-19 coverage mandates. Tests must be approved, cleared or authorized by the. CPT only copyright 2015 American Medical Association. The member's benefit plan determines coverage. If you purchase a test outside of your preferred network, your insurance company can cap your reimbursement fee at $12meaning that even if your COVID test costs upwards of $30, you will still . The site said more information on how members can submit claims will soon be available. Up to eight tests per 30-day period are covered. Yes, Aetna will cover tests approved, cleared or authorized by the U.S. Food and Drug Administration. Yes, Aetna will cover tests approved, cleared or authorized by the U.S. Food and Drug Administration. The policy . Get vaccine news, testing info and updated case counts. The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. Tests must be FDA-authorized. This information is available on the HRSA website. 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 test can be done by any authorized testing facility. Please log in to your secure account to get what you need. This mandate is in effect until the end of the federal public health emergency. They should check to see which ones are participating. Providers are encouraged to call their provider services representative for additional information. In the event a claim has already been processed prior to this policy going into effect, members should contact Customer Service so the claim can be reprocessed accordingly. Send it to the address shown on the form. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Do not respond if you get a call, text or email about "free" coronavirus testing. Tests used for employment, school or recreational purposes are not eligible for reimbursement unless required by state law. Call 1-800-Medicare (1-800-633-4227) with any questions about this initiative. And other FAQs. For members with CVS Caremark pharmacy benefits or whose employer covers these tests under medical benefits: Members with CVS Caremark & members whose plan sponsor is covering under medical. reimbursement scheme relies on people being able to find rapid COVID tests to buy either online or at their local pharmacy. CVS Health is actively monitoring the global COVID-19 pandemic including guidance from trusted sources of clinical information such as the Centers for Disease Control (CDC) and World Health Organization (WHO). 1-800-557-6059 | TTY 711, 24/7. 1 This applies to Medicare, Medicaid, and private insurers. 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 you dont see your patient coverage question here, let us know. Please log in to your secure account to get what you need. Tests must be purchased on or after January 15, 2022. Yes. 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. 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. Members will need to submit a claim for reimbursement through the Aetna website and will receive a check once the claim is approved. Detect Covid-19 test. 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. Yes. When billing, you must use the most appropriate code as of the effective date of the submission. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. However, you will likely be asked to scan a copy of . Others have four tiers, three tiers or two tiers. All claims received for Aetna-insured members going forward will be processed based on this new policy. Go to the American Medical Association Web site. 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. 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. 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. The member's benefit plan determines coverage. Under the federal governments current guidelines, tests are eligible if: Eligible tests include single-use, cartridge-based tests (for example, Flowflex, BinaxNow or Ongo). Some plans exclude coverage for services or supplies that Aetna considers medically necessary. 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. Aetna will cover up to eight (8) over the counter (OTC) at-home COVID-19 tests per 30-day period for each person covered under your plan. Tests must be approved, cleared or authorized by the. Aetna is complying with the CMS coding guidelines for COVID-19 lab testing. 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. Access trusted resources about COVID-19, including vaccine updates. It doesnt need a doctors order. Please be sure to add a 1 before your mobile number, ex: 19876543210. Thanks! These actions will be implemented under the amended Administrative Ruling (CMS-2020-1-R2) and coding instructions for the $25 add-on payment (HCPCS code U0005). For members with CVS Caremark pharmacy benefits or whose employer covers these tests under medical benefits: Members with CVS Caremark & members whose plan sponsor is covering under medical. Examples of such documentation could include the UPC code for the OTC COVID-19 test and/or a receipt from the seller of the test, documenting the date of purchase and the price of the OTC COVID-19 test. Tests must be used to diagnose a potential COVID-19 infection. CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. Please visit your local CVS Pharmacy or request . The requirement also applies to self-insured plans. If your pharmacy benefits are not with Aetna, contact your pharmacy benefits administrator for instructions. The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. 4. Refer to the U.S. Food & Drug Administration on tests that are eligible for coverage. Medical Reimbursement: COVID Over-the-Counter Test Form (PDF) . For more information and future updates, visit the CMS website and its newsroom. New and revised codes are added to the CPBs as they are updated. 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. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. If your reimbursement request is approved, a check will be mailed to you. 2. Those who have already purchased . CVS Health currently has more than 4,800 locations across the country offering COVID-19 testing. Please report any scams by calling 1-800-447-8477 or online at https://tips.oig.hhs.gov/. No fee schedules, basic unit, relative values or related listings are included in CPT. In addition, health insurers now provide or reimburse the cost of up to eight home tests per month for most . PPE, like other disposable infection control supplies, is part of the cost of the underlying procedure. INDICAID COVID-19 Rapid Antigen Test, 1 Pack, 2 Tests Total, 4 Easy Steps & Results in 20 Minutes - Covid OTC Nasal Swab Test - HSA/FSA Reimbursement Eligible INDICAID $16.50 $ 16 . Aetna: Aetna POSII, Aetna HDHP and Aetna POSII (ACA) Under the Aetna Plans COVID testing is currently covered at 100% for provider visits in and out of network. $35.92. Tests must be FDA authorized in accordance with the requirements of the CARES Act. You can also use it to pay for medical, dental and vision bills, including telehealth and COVID-19 treatment. 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 more information on test site locations in a specific state, please visit CVS.com. Some subtypes have five tiers of coverage. 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. 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. Each main plan type has more than one subtype. This member cost-sharing waiver applies to all Commercial, Medicare and Medicaid lines of business. 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. No. Meanwhile, the agency said that Medicare pays for Covid-19 tests performed by a laboratory at no cost when the test is ordered by a physician or other health care provider. Consumers will have the option to either order tests online for free or purchase a test in-store and submit receipts to their insurance company for reimbursement. Your employer or health plan will have the best information on how to buy OTC COVID-19 tests that will be covered. Links to various non-Aetna sites are provided for your convenience only. 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. As omicron has soared, the tests' availability seems to have plummeted. 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: 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. Last update: February 1, 2023, 4:30 p.m. CT. Aetna Better Health plan pricing may be determined by each individual health plan in accordance with its state contracts. If you don't see your testing and treatment questions here, let us know. Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search. In response to COVID-19, MassHealth has taken steps to create flexibilities for providers; expand benefits, including coverage of services delivered via telehealth; and expand eligibility for residents of the Commonwealth. Rates may vary for Commercial Plans based on factors such as billed charges or contractual terms. If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. 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). . In addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members. This mandate is in effect until the end of the federal public health emergency. Care providers are responsible for submitting accurate claims in accordance with state and federal laws and UnitedHealthcare's reimbursement policies. Although the federal government is not providing free tests at this time, it has taken steps to ensure that people are able to get free tests through their health insurance - Medicare included. Tests must be used to diagnose a potential COVID-19 infection. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Links to various non-Aetna sites are provided for your convenience only. 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. While you can no longer get free COVID-19 test kits from the federal government, if you have health insurance, you're covered for eight free over-the-counter, at-home COVID-19 tests each month.So if you have health insurance through your employer, or if you have a plan through the Affordable Care Act's marketplace, each person on your plan can get eight tests per month. 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. 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). You, your employees and agents are authorized to use CPT only as contained in Aetna Precertification Code Search Tool solely for your own personal use in directly participating in health care programs administered by Aetna, Inc. You acknowledge that AMA holds all copyright, trademark and other rights in CPT.