Please log in to your secure account to get what you need. Links to various non-Aetna sites are provided for your convenience only. 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. Medicare covers one of these PCR kits per year at $0. However, you will likely be asked to scan a copy of . The updated vaccine targets the original COVID-19 viral strain and 2 Omicron variants (BA.4/BA.5). 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. Providers will bill Medicare. For example, Binax offers a package with two tests that would count as two individual tests. Yes, patients must register in advance at CVS.com to schedule an appointment. CPT is a registered trademark of the American Medical Association. Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. . U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements. Between January 15 and January 30, just 0.5 percent of Blue Cross Blue Shield of Massachusetts subscribers filed COVID test reimbursement claims, WBUR reported last month. 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)*. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. 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. 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. Applicable FARS/DFARS apply. 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. Yes. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. 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. Americans with private insurance will be able to ask for reimbursement for rapid COVID-19 tests beginning Saturday but any tests purchased before January 15 will not qualify. 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. Postal Service will ship the tests directly to your door free of charge. The tests come at no extra cost. If you do not intend to leave our site, close this message. Commercial labs are in the process of updating their provider community about their capabilities and how to order tests. 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. Please note that copays, deductibles and coinsurance will apply according to the members benefit plan. Note: Each test is counted separately even if multiple tests are sold in a single package. Applicable FARS/DFARS apply. Tests used for employment, school or recreational purposes are not eligible for reimbursement unless required by state law. 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). MINNEAPOLIS On Tuesday, White House Press Secretary Jen Psaki tweeted that the Biden administration will make sure every insured American can get reimbursed for their at-home COVID tests. For example, Binax offers a package with two tests that would count as two individual tests. If you don't see your testing and treatment questions here, let us know. Members should discuss any matters related to their coverage or condition with their treating provider. Providers can seek reimbursement for uninsured patients through the Health Resources & Services Administration (HRSA) for COVID-19 testing, treatment and vaccine administration. Covers up to eight (8) rapid antigen single-test kits or four (4) rapid antigen two-test kits per month. Get PCR tests and antigen tests through a lab at no cost when a doctor or other health care professional orders it for you. Using FSA or HSA Funds. 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 . Refer to the CDC website for the most recent guidance on antibody testing. You can find a partial list of participating pharmacies at Medicare.gov. The member's benefit plan determines coverage. Your employer or health plan will have the best information on how to buy OTC COVID-19 tests that will be covered. 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. 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. Get started with your reimbursement request. Aetna Better Health will cover the treatment of COVID-19 or health complications associated with COVID-19. If this happens, you can pay for the test, then submit a request for reimbursement. 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. If you have private, employer-sponsored or student health commercial insurance youre eligible to get reimbursed for over-the-counter at-home COVID kits. Any COVID-19 test ordered by your physician is covered by your insurance plan. The free at-home COVID-19 test program ran from January 19, 2022 to September 2, 2022. The information you will be accessing is provided by another organization or vendor. Please call your medical benefits administrator for your testing coverage details. 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. 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. Medicare covers the updated COVID-19 vaccine at no cost to you. National labs will not collect specimens for COVID-19 testing. Starting Saturday, private health plans are required to cover . When billing, you must use the most appropriate code as of the effective date of the submission. 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. 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. 2Disclaimer: Regulations regarding testing for Aetna Medicaid members vary by state and, in some cases, may change in light of the current situation. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. Any test ordered by your physician is covered by your insurance plan. In addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members. By providing us with your email address, you agree to receive email communications from Aetna until you opt out of further emails. The test will be sent to a lab for processing. 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. 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. 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. You can find a partial list of participating pharmacies at Medicare.gov. 1Aetna will follow all federal and state mandates for insured plans, as required. Postal Service. While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. 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. 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. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Refer to the U.S. Food & Drug Administration on tests that are eligible for coverage. Yes. Last update: February 1, 2023, 4:30 p.m. CT. 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). Tests must be FDA-authorized. Your pharmacy plan should be able to provide that information. The following are some of the national labs approved to do COVID-19 testing(other commercial labs are also approved): There are other participating commercial labs, hospitals and urgent care centers authorized to provide COVID-19 lab testing. The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. 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. Detect Covid-19 test. This applies whether you purchased your 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. 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. Your commercial plan will reimburse you up to $12 per test. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. This policy for diagnostic and antibody testing applies to Commercial, Medicare and Medicaid plans.2. Our ability to coordinate the availability of COVID-19 testing bolsters states efforts to manage the spread of the virus. If your reimbursement request is approved, a check will be mailed to you. 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. The tests come at no extra cost. $51.33. Do you want to continue? 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. In case of a conflict between your plan documents and this information, the plan documents will govern. 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. If you have private, employer-sponsored or student health commercial insurance youre eligible to get reimbursed for over-the-counter at-home COVID kits. Each main plan type has more than one subtype. 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 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. For CVS Health testing initiatives, see section titled, COVID-19 drive-thru testing at CVS Pharmacy locations. Home Test Kit Reimbursement. Due to high demand for OTC at-home COVID-19 tests, supplies may be limited in some areas. 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. In a . 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. Health benefits and health insurance plans contain exclusions and limitations. 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. Tests must be FDA authorized in accordance with the requirements of the CARES Act. 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. Treating providers are solely responsible for dental advice and treatment of members. Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept". Members should take their red, white and blue Medicare card when they pick up their tests. The American Medical Association (AMA) does not directly or indirectly practice medicine or dispense medical services. 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. During the COVID-19 PHE, get one lab-performed test without a health care professional's order, at no cost. Care providers are responsible for submitting accurate claims in accordance with state and federal laws and UnitedHealthcare's reimbursement policies. 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. Reimbursement for 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV testing using any technique multiple types, subtypes (includes all targets) Reimbursement. 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. You are now being directed to the CVS Health site. In addition, health insurers now provide or reimburse the cost of up to eight home tests per month for most . The U.S. Stay up to date and find state resources, like testing sites, updated case counts, facts from the Centers for Disease Control and more. 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. The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. 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). For more information on test site locations in a specific state visit CVS. As omicron has soared, the tests' availability seems to have plummeted. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider.