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. You are not eligible if you have Medicare, Medicare Supplement, Medicaid, or voluntary insurance. 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. Providers will bill Medicare. Get started with your reimbursement request. 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.This mandate is in effect until the end of the federal . 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. Subject to applicable law, Aetna may deny tests that do not meet medical necessity criteria. 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. 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: 2020 claims eligible for the 20% increase in the MS-DRG weighting factor will also be required to have a . 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. Note: Each test is counted separately even if multiple tests are sold in a single package. Tests used for employment, school or recreational purposes are not eligible for reimbursement unless required by state law. Visit the World Health Organization for global news on COVID-19. Tests must be FDA authorized in accordance with the requirements of the CARES Act. The ABA Medical Necessity Guidedoes not constitute medical advice. 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. Links to various non-Aetna sites are provided for your convenience only. The requirement also applies to self-insured plans. Please report any scams by calling 1-800-447-8477 or online at https://tips.oig.hhs.gov/. 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. Members should discuss any matters related to their coverage or condition with their treating provider. This mandate is in effect until the end of the federal public health emergency. 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. Our pharmacies and MinuteClinics are uniquely positioned to help address the pandemic and protect peoples health. 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. 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. 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. Aetna will cover, without cost share, serological (antibody) tests that are ordered by a physician or authorized health care professional and are medically necessary. That's beginning to change, however. 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 . At this time, covered tests are not subject to frequency limitations. 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. 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. 2Disclaimer: Regulations regarding testing for Aetna Medicaid members vary by state and, in some cases, may change in light of the current situation. Members will need to submit a claim for reimbursement through the Aetna website and will receive a check once the claim is approved. 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. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. New and revised codes are added to the CPBs as they are updated. Medicare covers one of these PCR kits per year at $0. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Do not give out your Aetna member ID number or other personal information. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. 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. 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. 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. This page provides MassHealth Coronavirus Disease (COVID-19) guidance and information for all MassHealth providers. Referrals from University Health Services for off-campus medical care will again be required. The new states are Alabama, Arkansas, Colorado, Delaware, Iowa, Mississippi, Montana, North Dakota, Oregon and West Virginia. If you don't see your testing and treatment questions here, let us know. 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 . CPT only Copyright 2022 American Medical Association. If this happens, you can pay for the test, then submit a request for reimbursement. 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. Health benefits and health insurance plans contain exclusions and limitations. 1 This applies to Medicare, Medicaid, and private insurers. 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. Members should discuss any Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider. 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. *The content below is not intended to be a substitute for professional medical advice, diagnosis or treatment. Visit the secure website, available through www.aetna.com, for more information. For language services, please call the number on your member ID card and request an operator. This information is neither an offer of coverage nor medical advice. Box 981106, El Paso, TX 79998-1106. Others have four tiers, three tiers or two tiers. Aetna Medicare plans do not reimburse for OTC COVID-19 tests. Those using a non-CDC test will be reimbursed $51 . Note: Each test is counted separately even if multiple tests are sold in a single package. A list of approved tests is available from the U.S. Food & Drug Administration. 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. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. 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. This benefit does not apply to Aetna Better Heath of New York, since medical benefits are not covered. If you're on Medicare, there's also a . Some plans exclude coverage for services or supplies that Aetna considers medically necessary. 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. And other FAQs. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. This includes the testing only not necessarily the Physician visit. 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. You can also call Aetna Member Services by . 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. The test can be done by any authorized testing facility. Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept". 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. Below is information about policies and procedures that CVS Health has implemented that focus on the health and safety of our colleagues, customers, members and patients. CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. 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 . Aetna will cover treatment of COVID-19 for our Medicare Advantage members. 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. 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. Americans with health insurance can get up to eight at-home coronavirus tests for free thanks to a new requirement. This does not apply to Medicare. This mandate is in effect until the end of the federal public health emergency. 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. The health insurance company Aetna has a guide on . Providers can seek reimbursement for uninsured patients through the Health Resources & Services Administration (HRSA) for COVID-19 testing, treatment and vaccine administration. Aetna is working to protect you from COVID-19 scams. 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. 1-800-557-6059 | TTY 711, 24/7. Your pharmacy plan should be able to provide that information. Learn more about what's covered and what you need to do to get reimbursed, and get answers to other frequently asked questions about at-home COVID-19 self-test coverage. Home Test Kit Reimbursement. Pharmacists, in partnership with other health care providers, are well positioned to aid COVID-19 testing expansion. Visit www.covidtests.gov to learn more. Insurance companies are still figuring out the best system to do . Your employer or health plan will have the best information on how to buy OTC COVID-19 tests that will be covered. Please note that copays, deductibles and coinsurance will apply according to the members benefit plan. While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. Starting Saturday, private health plans are required to cover . Aetna Medicare members can obtain OTC COVID-19 tests from participating providers and pharmacies, but will not be reimbursed for self-purchased tests. 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. The AMA is a third party beneficiary to this Agreement. While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. Learn whats covered and the steps to get reimbursed. 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. The member's benefit plan determines coverage. Links to various non-Aetna sites are provided for your convenience only. 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). The test will be sent to a lab for processing. 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. Do not respond if you get a call, text or email about "free" coronavirus testing. 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). So if someone calls you to sell you an insurance policy or change your current policy even if the person says they represent Aetna call us first at the number on your ID card or 1-800-872-3862 (TTY: 711). 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 . For example, Binax offers a package with two tests that would count as two individual tests. Each main plan type has more than one subtype. While the Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. 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.This mandate is in effect until the end of the federal . The reality may be far different, adding hurdles for . *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. For CVS Health testing initiatives, see section titled, COVID-19 drive-thru testing at CVS Pharmacy locations. Lab-based PCR home collection kits are not covered at this time by the OTC kit mandate. You can find a partial list of participating pharmacies at Medicare.gov. 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. Postal Service. Yes. This allows us to continue to help slow the spread of the virus. Be sure to check your email for periodic 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. You are now being directed to CVS caremark site. If as part of that visit the provider administers or orders a test for influenza, strep, or other respiratory infection, that additional testing will also be covered without member cost sharing. A parent or legal guardian must complete the on-line registration for all minor patients, and patients 3 to 15 years of age must be accompanied by a parent or legal guardian when they come to be tested. This includes those enrolled in a Medicare Advantage plan. Pharmacists, in partnership with other health care providers, are well positioned to aid COVID-19 testing expansion. 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. 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 suspect price gouging or a scam, contact your state . Members should take their red, white and blue Medicare card when they pick up their tests. Aetna is reaching out to the commercial labs about their ability to provide the COVID-19 testing. 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. The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. Important: Use your Aetna ID that starts with a "W.". You can administer the test and read the results yourself, without the help of a health care provider, Have to be sent to a lab (for example, Pixel, MyLab Box), Require a health care professional (doctor or nurse) to administer or read the test (for example, PCR or rapid tests). Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. Members should discuss any matters related to their coverage or condition with their treating provider. COVID-19 Testing, Treatment, Coding & Reimbursement. Self-insured plan sponsors offered this waiver at their discretion. 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. TTY users can call 1-877-486-2048. CPT only copyright 2015 American Medical Association. 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. Members should take their red, white and blue Medicare card when they pick up their tests. Please visit your local CVS Pharmacy or request . 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. 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. Aetna Better Health will cover the treatment of COVID-19 or health complications associated with COVID-19. 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. Disclaimer of Warranties and Liabilities. It doesnt need a doctors order. Using FSA or HSA Funds. 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. 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. Unlisted, unspecified and nonspecific codes should be avoided. 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. 1Aetna will follow all federal and state mandates for insured plans, as required. Others have four tiers, three tiers or two tiers. Aetna will accept claims for reimbursement for tests purchased at out-of-network retailers. The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. If you do not intend to leave our site, close this message. You can find a partial list of participating pharmacies at Medicare.gov. 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. In addition, Aetna is waiving member cost-sharing for diagnostic testing related to COVID-19. Go to the American Medical Association Web site. National labs will not collect specimens for COVID-19 testing. Laboratories using the test developed by the Center for Disease Control and Prevention (CDC) would be reimbursed $36 per test. 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 . $35.92. 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. 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. Refer to the U.S. Food & Drug Administration on tests that are eligible for coverage. 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. LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). Since January 2022, health insurance plans have been required to cover the cost of at-home rapid tests for COVID-19.

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