If you are not on UHART's . 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. Since January 2022, health insurance plans have been required to cover the cost of at-home rapid tests for COVID-19. CMS established these requirements to support faster high throughput COVID-19 diagnostic testing and to ensure all patients (not just Medicare patients) benefit from faster testing. Please refer to the FDA and CDC websites for the most up-to-date information. (Offer to transfer member to their PBMs customer service team.). These reimbursement rates for COVID-19 diagnostic and antibody testing are based on rates announced by CMS. 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. Home Test Kit Reimbursement. 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. All Rights Reserved. Who the tests are for (self or dependent), Your pharmacy plan should be able to provide that information. For language services, please call the number on your member ID card and request an operator. 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. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. Yes. CPT is a registered trademark of the American Medical Association. The tests come at no extra cost. Please visit your local CVS Pharmacy or request . 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. This policy for diagnostic and antibody testing applies to Commercial, Medicare and Medicaid plans.2. If your reimbursement request is approved, a check will be mailed to you. Covers up to eight (8) rapid antigen single-test kits or four (4) rapid antigen two-test kits per month. Even if the person gives you a different number, do not call it. A list of approved tests is available from the U.S. Food & Drug Administration. Important: Use your Aetna ID that starts with a "W.". A list of approved tests is available from the U.S. Food & Drug Administration. 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. National labs will not collect specimens for COVID-19 testing. 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. The AMA disclaims responsibility for any consequences or liability attributable or related to any use, nonuse or interpretation of information contained in Aetna Clinical Policy Bulletins (CPBs). Testing will not be available at all CVS Pharmacy locations. Biden free COVID tests plan. Lab-based PCR home collection kits are not covered at this time by the OTC kit mandate. 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 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 . No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM. You can also call Aetna Member Services by . That's beginning to change, however. In addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members. This waiver may remain in place in states where mandated. When billing, you must use the most appropriate code as of the effective date of the submission. Our ability to coordinate the availability of COVID-19 testing bolsters states efforts to manage the spread of the virus. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. 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. Sign in or register at Caremark.com (You must be a CVS Caremark member) Visit the secure website, available through www.aetna.com, for more information. 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. Please be sure to add a 1 before your mobile number, ex: 19876543210. You can submit up to 8 tests per covered member per month. Do you want to continue? Aetna Medicare plans do not reimburse for OTC COVID-19 tests. Tests used for employment, school or recreational purposes are not eligible for reimbursement unless required by state law. It doesnt need a doctors order. The AMA disclaims responsibility for any consequences or liability attributable or related to any use, nonuse or interpretation of information contained in Aetna Clinical Policy Bulletins (CPBs). All forms are printable and downloadable. The free at-home COVID-19 test program ran from January 19, 2022 to September 2, 2022. No, Aetna will pay the amount of the cost-sharing the member would have ordinarily paid so the provider would receive the same total payment. 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. 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. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Members should discuss any Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider. Links to various non-Aetna sites are provided for your convenience only. Tests must be approved, cleared or authorized by the. You are now being directed to CVS caremark site. Go to the American Medical Association Web site. Our pharmacies and MinuteClinics are uniquely positioned to help address the pandemic and protect peoples health. 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. You may opt out at any time. The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. In case of a conflict between your plan documents and this information, the plan documents will govern. Visit www.covidtests.gov to learn more. Tests must be FDA-authorized. 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. $35.92. Reimbursement for using the CDC 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Panel. Now, however, anyone in the U.S. can order a total of four free tests per household via COVIDtests.gov. 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. Medical Reimbursement: COVID Over-the-Counter Test Form (PDF) . Go to the American Medical Association Web site. Please be sure to add a 1 before your mobile number, ex: 19876543210. 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. 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. COVID-19 testing, vaccines, hospitalizations and related expenses will return to the standard coverage for in-network and out of network services. 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 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). 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. 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. 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. Aetna updated its website Friday with new frequently asked questions about the new requirement. Refer to the U.S. Food & Drug Administration on tests that are eligible for coverage. 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 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. 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. 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. For more information, see the attached Guidance for COVID-19 OTC Testing 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. 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). 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. 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. Your pharmacy plan should be able to provide that information. 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. As omicron has soared, the tests' availability seems to have plummeted. 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. 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. 1Aetna will follow all federal and state mandates for insured plans, as required. Members should take their red, white and blue Medicare card when they pick up their tests. 2Disclaimer: Regulations regarding testing for Aetna Medicaid members vary by state and, in some cases, may change in light of the current situation. The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. Health benefits and health insurance plans contain exclusions and limitations. Your commercial plan will reimburse you up to $12 per test. If your pharmacy benefits are not with Aetna, contact your pharmacy benefits administrator for instructions. Box 981106, El Paso, TX 79998-1106.