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 five character codes included in the Aetna Clinical Policy Bulletins (CPBs) are obtained from Current Procedural Terminology (CPT), copyright 2015 by the American Medical Association (AMA). (For example, BinaxNOW offers a package with two tests included that would count as two individual tests). PPE, like other disposable infection control supplies, is part of the cost of the underlying procedure. Description. The tests, part of the administration's purchase of 500 million tests last . Detect Covid-19 test. Unlisted, unspecified and nonspecific codes should be avoided. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. This page provides MassHealth Coronavirus Disease (COVID-19) guidance and information for all MassHealth providers. 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. You are not eligible if you have Medicare, Medicare Supplement, Medicaid, or voluntary insurance. 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. All claims received for Aetna-insured members going forward will be processed based on this new policy. Building on the companys comprehensive efforts to help slow the spread of the virus, we can bring safe and effective testingoptions closer to home and help increase access to testing options for even more individuals. 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). The free at-home COVID-19 test program ran from January 19, 2022 to September 2, 2022. Up to eight tests per 30-day period are covered. Health benefits and health insurance plans contain exclusions and limitations. 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. 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. Treating providers are solely responsible for medical advice and treatment of members. Those who have already purchased . The American Medical Association (AMA) does not directly or indirectly practice medicine or dispense medical services. Be sure to check your email for periodic updates. 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 may opt out at any time. Applicable FARS/DFARS apply. Applicable FARS/DFARS apply. At this time, covered tests are not subject to frequency limitations. The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. 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 can find a partial list of participating pharmacies at Medicare.gov. The AMA is a third party beneficiary to this Agreement. For example, some UnitedHealthcare plans cover up to $40 of OTC products per quarter, which would cover the cost of 3 COVID-19 tests every 3 months (based on the $12 reimbursement rate being used . Links to various non-Aetna sites are provided for your convenience only. When billing, you must use the most appropriate code as of the effective date of the submission. CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. This member cost-sharing waiver applies to all Commercial, Medicare and Medicaid lines of business. 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. To ensure access for COVID-19 testing and have consistent reimbursement, Aetnawill reimburse contracted and non-contracted providers for COVID-19 testing as follows in accordance with the members benefit plan3. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. 5. Applicable FARS/DFARS apply. 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). . The new states are Alabama, Arkansas, Colorado, Delaware, Iowa, Mississippi, Montana, North Dakota, Oregon and West Virginia. 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. The member's benefit plan determines coverage. 2. You can find a partial list of participating pharmacies at Medicare.gov. Yes. 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. For the time being, you'll have to submit a claim to get reimbursed after you buy tests. Aetna is working to protect you from COVID-19 scams. Members should take their red, white and blue Medicare card when they pick up their tests. Those using a non-CDC test will be reimbursed $51 . Recently, the United States government made available four free at-home COVID-19 tests to each home address upon request. This Agreement will terminate upon notice if you violate its terms. COVID-19 home test kit returns will not be accepted. 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. 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. Get vaccine news, testing info and updated case counts. Covers up to eight (8) rapid antigen single-test kits or four (4) rapid antigen two-test kits per month. Access trusted resources about COVID-19, including vaccine updates. 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. For more information about the virus, please visit the CDC and/or WHO websites dedicated to this issue. If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. 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. 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. 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. Go to the pharmacy website or call the relevant pharmacy to confirm participating locations and get details on how to order. 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 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. Any test ordered by your physician is covered by your insurance plan. 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. Please note also that Dental Clinical Policy Bulletins (DCPBs) are regularly updated and are therefore subject to change. Aetna will cover treatment of COVID-19 for our Medicare Advantage members. If your pharmacy benefits are not with Aetna, contact your pharmacy benefits administrator for instructions. 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. 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. Tests must be approved, cleared or authorized by the. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. 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. In addition, coverage may be mandated by applicable legal requirements of a State or the Federal government. Thanks! This also applies to Medicare and Medicaid plan coverage. Members must get them from participating pharmacies and health care providers. 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. This includes those enrolled in a Medicare Advantage plan. 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-results testing. 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 . The site said more information on how members can submit claims will soon be available. 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. This policy for diagnostic and antibody testing applies to Commercial, Medicare and Medicaid plans.2. 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 . 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 . Patients will need to pre-register, provide their insurance information as appropriate and verify their eligibility for testing. New and revised codes are added to the CPBs as they are updated. Biden free COVID tests plan. No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM. Yes. Once completed you can sign your fillable form or send for signing. The omicron surge may be receding in Michigan, but more than 13,000 in the state are still testing . Get a COVID-19 vaccine as soon as you can. CPT only copyright 2015 American Medical Association. If you suspect price gouging or a scam, contact your state . As the insurer Aetna says . 50 (218) Each site operated seven days a week, providing results to patients on-site, through the end of June. At this time, covered tests are not subject to frequency limitations. HCPCS code. You can continue to use your HSA even if you lose your job. On March 16, the CMS released details about how COVID-19 testing would be reimbursed to health care providers administering the tests. This waiver may remain in place in states where mandated. Please be sure to add a 1 before your mobile number, ex: 19876543210. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. . Each main plan type has more than one subtype. They may also order up to two sets of four at-home tests per household by visiting COVIDtests.gov. In addition, health insurers now provide or reimburse the cost of up to eight home tests per month for most . Aetna Better Health plan pricing may be determined by each individual health plan in accordance with its state contracts. Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. The tests come at no extra cost. 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. If you don't see your testing and treatment questions here, let us know. Kaiser members can go to " Coverage & Costs " and select "Submit a medical claim.". 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. You are not eligible if you have Medicare, Medicare Supplement, Medicaid, or voluntary insurance. 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. Blue Shield of California, Care First, Cigna, CVS Group/Aetna, and Kaiser Permanente) are currently relying only on reimbursement . Reimbursement for 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV testing using any technique multiple types, subtypes (includes all targets) Reimbursement. The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. For example, Binax offers a package with two tests that would count as two individual tests. 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. 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. Your pharmacy plan should be able to provide that information. Medicare covered OTC COVID tests are provided by participating providers and pharmacies. Once they have registered, the patient will be provided with an appointment window for up to seven days in advance. Links to various non-Aetna sites are provided for your convenience only. Please call your medical benefits administrator for your testing coverage details. A list of approved tests is available from the U.S. Food & Drug Administration. . 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). 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. The information you will be accessing is provided by another organization or vendor. For members with Aetna pharmacy benefits, you can submit a claim for reimbursement through your Aetna member website. 3Rates above are not applicable to Aetna Better Health Plans. Do you want to continue? Please note also that the ABA Medical Necessity Guidemay be updated and are, therefore, subject to change. If you dont see your patient coverage question here, let us know. If you buy a test at an out-of-network provider, your insurance may only cover $12 of the cost, and you'll be responsible for paying the rest. 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. They should check to see which ones are participating. You can find a partial list of participating pharmacies at Medicare.gov. 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. CVS Pharmacy, HealthHUB and MinuteClinic will continue to serve customers and patients. These guidelines do not apply to Medicare. If you do not intend to leave our site, close this message. 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. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. 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. Testing will not be available at all CVS Pharmacy locations. Our pharmacies and MinuteClinics are uniquely positioned to help address the pandemic and protect peoples health. The claim must include an itemized purchase receipt and the COVID-19 test's QR or UPC code, cut out of . Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept". Postal Service. 2Disclaimer: Regulations regarding testing for Aetna Medicaid members vary by state and, in some cases, may change in light of the current situation. It is only a partial, general description of plan or program benefits and does not constitute a contract. Aetna is reaching out to the commercial labs about their ability to provide the COVID-19 testing. 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 . If you have private, employer-sponsored or student health commercial insurance youre eligible to get reimbursed for over-the-counter at-home COVID kits. This mandate is in effect until the end of the federal public health emergency. Aetna members can now receive reimbursement for test kits purchased on or after Jan. 15, 2022. 1Aetna will follow all federal and state mandates for insured plans, as required. 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. This benefit does not apply to Aetna Better Heath of New York, since medical benefits are not covered. Patrick T. Fallon/AFP/Getty Images via Bloomberg. Note: Each test is counted separately even if multiple tests are sold in a single package. Tests must be FDA-authorized. Who the tests are for (self or dependent), Your pharmacy plan should be able to provide that information. The member's benefit plan determines coverage. 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. Refer to the U.S. Food & Drug Administration on tests that are eligible for coverage. 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. While the Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. The Biden Administration said it will make sure every insured American can get a reimbursement by around Jan. 15. . Subject to applicable law, Aetna may deny tests that do not meet medical necessity criteria. Once they have registered, the patient will be provided with an appointment window forup to seven days in advance. Please note that copays, deductibles and coinsurance will apply according to the members benefit plan. Tests used for employment, school or recreational purposes are not eligible for reimbursement unless required by state law. 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. Rates may vary for Commercial Plans based on factors such as billed charges or contractual terms. This member cost-sharing waiver applies to all Commercial, Medicare and Medicaid lines of business. Medicare now covers up to 8 over-the-counter COVID-19 tests each calendar month, at no cost to you. 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. 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. 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. Pharmacists, in partnership with other health care providers, are well positioned to aid COVID-19 testing expansion. For language services, please call the number on your member ID card and request an operator. All Rights Reserved. 2020 claims eligible for the 20% increase in the MS-DRG weighting factor will also be required to have a . If you have private, employer-sponsored or student health commercial insurance youre eligible to get reimbursed for over-the-counter at-home COVID kits. Providers will bill Medicare. 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. For CVS Health testing initiatives, see section titled, COVID-19 drive-thru testing at CVS Pharmacy locations. 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. Each main plan type has more than one subtype. 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. 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. While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. Coverage is available for members eligible with Medicare Part B FFS or Medicare Advantage Benefits. Aetna is in the process of developing a direct-to-consumer shipping option. 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. Your employer or health plan will have the best information on how to buy OTC COVID-19 tests that will be covered.