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. 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)*. Medical Reimbursement: COVID Over-the-Counter Test Form (PDF) . (Offer to transfer member to their PBMs customer service team.). The member's benefit plan determines coverage. Aetna is reaching out to the commercial labs about their ability to provide the COVID-19 testing. Tests must be purchased on or after January 15, 2022. These forms are usually returned by mail, and you'll most likely find the address for where to mail it on the form itself. *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. HCPCS code. Last update: February 1, 2023, 4:30 p.m. CT. For people . Please note: Your receipt must be dated January 15, 2022 or later to be eligible for reimbursement. 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. Access trusted resources about COVID-19, including vaccine updates. There are two main ways to purchase these tests. Sign in or register at Caremark.com (You must be a CVS Caremark member) Description. Testing will not be available at all CVS Pharmacy locations. To help improve access to these tests, the Biden-Harris Administration is expanding access to free at-home kits through the federal government. A list of approved tests is available from the U.S. Food & Drug Administration. 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. 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. 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. No fee schedules, basic unit, relative values or related listings are included in CPT. You can find a partial list of participating pharmacies at Medicare.gov. Once they have registered, the patient will be provided with an appointment window forup to seven days in advance. Medicare now covers up to 8 over-the-counter COVID-19 tests each calendar month, at no cost to you. Postal Service. 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. At this time, covered tests are not subject to frequency limitations. 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. That's beginning to change, however. Note: Each test is counted separately even if multiple tests are sold in a single package. Blue Shield of California, Care First, Cigna, CVS Group/Aetna, and Kaiser Permanente) are currently relying only on reimbursement . Stay up to date and find state resources, like testing sites, updated case counts, facts from the Centers for Disease Control and more. Members should discuss any matters related to their coverage or condition with their treating provider. Members must get them from participating pharmacies and health care providers. 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. (For example, BinaxNOW offers a package with two tests included that would count as two individual tests). You are now being directed to the CVS Health site. If your reimbursement request is approved, a check will be mailed to you. Medicare member reimbursement amount per test may vary by Medicare plan. . Do you want to continue? Any test ordered by your physician is covered by your insurance plan. $51.33. 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. At-home COVID-19 tests are excluded from all coupon discounts and promotions, including CarePass and ExtraBucks Rewards . 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. Referrals from University Health Services for off-campus medical care will again be required. Visit the World Health Organization for global news on COVID-19. For now, the only submission instructions are to fax the completed form to 859-410-2422 or physically mail it along with any receipts to the address on the back of your health insurance card. Treating providers are solely responsible for medical advice and treatment of members. 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. 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. Note: Each test is counted separately even if multiple tests are sold in a single package. You can continue to use your HSA even if you lose your job. The updated vaccine targets the original COVID-19 viral strain and 2 Omicron variants (BA.4/BA.5). This member cost-sharing waiver applies to all Commercial, Medicare and Medicaid lines of business. 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. Tests must be approved, cleared or authorized by the. 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. 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. Tests used for employment, school or recreational purposes are not eligible for reimbursement unless required by state law. 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. Treating providers are solely responsible for medical advice and treatment of members. The policy . For more information, see the attached Guidance for COVID-19 OTC Testing Coverage. 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. 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 . 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. It is only a partial, general description of plan or program benefits and does not constitute a contract. 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. Aetna complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, creed, religious ailiation, ancestry, sex gender . The tests, part of the administration's purchase of 500 million tests last . 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. The claim must include an itemized purchase receipt and the COVID-19 test's QR or UPC code, cut out of . 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. CPT only Copyright 2022 American Medical Association. This benefit does not apply to Aetna Better Heath of New York, since medical benefits are not covered. Any test ordered by your physician is covered by your insurance plan. All services deemed "never effective" are excluded from coverage. Members should discuss any Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider. In a . Patients will need to pre-register, provide their insurance information as appropriate and verify their eligibility for testing. Aetna's 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). 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. Please note that copays, deductibles and coinsurance will apply according to the members benefit plan. 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. Aetna Medicare plans do not reimburse for OTC COVID-19 tests. This search will use the five-tier subtype. These guidelines do not apply to Medicare. . The tests come at no extra cost. If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. 2Disclaimer: Regulations regarding testing for Aetna Medicaid members vary by state and, in some cases, may change in light of the current situation. Commercial labs are in the process of updating their provider community about their capabilities and how to order tests. Complete this form for each covered member. 4. This allows us to continue to help slow the spread of the virus. A list of approved tests is available from the U.S. Food & Drug Administration. For CVS Health testing initiatives, see section titled, COVID-19 drive-thru testing at CVS Pharmacy locations. Note: Each test is counted separately even if multiple tests are sold in a single package. 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 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. And other FAQs. Please report any scams by calling 1-800-447-8477 or online at https://tips.oig.hhs.gov/. This mandate is in effect until the end of the federal public health emergency. You can find a partial list of participating pharmacies at Medicare.gov. All Rights Reserved. Rates may vary for Commercial Plans based on factors such as billed charges or contractual terms. If you have any questions on filling out the form, please call 1-888-238-6240. The following rates are used for COVID-19 testing for commercial and Medicare plans, unless noted otherwise: Diagnostic testing/handling rates - Medicare. If you don't see your testing and treatment questions here, let us know. Any test ordered by your physician is covered by your insurance plan. 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 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 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. 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). (Offer to transfer member to their PBMs customer service team.). 1 This applies to Medicare, Medicaid, and private insurers. 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 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. The specimen should be sent to these laboratories using standard procedures. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. Testing will not be available at all CVS Pharmacy locations. $35.92. The information you will be accessing is provided by another organization or vendor. Applicable FARS/DFARS apply. 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. 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. Any COVID-19 test ordered by your physician is covered by your insurance plan. Yes, patients must register in advance at CVS.comto schedule an appointment. Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. 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: 1-800-557-6059 | TTY 711, 24/7. New and revised codes are added to the CPBs as they are updated. 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. CVS Pharmacy, HealthHUB and MinuteClinic will continue to serve customers and patients. The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. U0002. For more information about the virus, please visit the CDC and/or WHO websites dedicated to this issue. For language services, please call the number on your member ID card and request an operator. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. 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. 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. Visit the secure website, available through www.aetna.com, for more information. Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. The member's benefit plan determines coverage. 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. In addition, coverage may be mandated by applicable legal requirements of a State or the Federal government. The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. Download the form below and mail to: Aetna, P.O. Who the tests are for (self or dependent), Your pharmacy plan should be able to provide that information. Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. OTC COVID-19 tests can be purchased at pharmacies, retail locations or online. 2Disclaimer: Regulations regarding testing for Aetna Medicaid members vary by state and, in some cases, may change in light of the current situation. While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. Insurance companies are still figuring out the best system to do . 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. All claims received for Aetna-insured members going forward will be processed based on this new policy. Do not give out your Aetna member ID number or other personal information. You should expect a response within 30 days. Go to the pharmacy website or call the relevant pharmacy to confirm participating locations and get details on how to order. Your benefits plan determines coverage. 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. 2. 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. At this time, covered tests are not subject to frequency limitations. 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. 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. It doesnt need a doctors order. The tests were shipped through the U.S. You should expect a response within 30 days. 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. If you are not on UHART's . CVS Health currently has more than 4,800 locations across the country offering COVID-19 testing. 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. Lab-based PCR home collection kits are not covered at this time by the OTC kit mandate. 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. CPT is a registered trademark of the American Medical Association. This information helps us provide information tailored to your Medicare eligibility, which is based on age. If you dont see your patient coverage question here, let us know. Medicare covers one of these PCR kits per year at $0. Due to high demand for OTC at-home COVID-19 tests, supplies may be limited in some areas. Copyright 2015 by the American Society of Addiction Medicine. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Tests used for employment, school or recreational purposes are not eligible for reimbursement unless required by state law. Parents or guardians seeking testing for children under the age of 10 (or the age of 5 for rapid-result testing) should consult with a pediatrician to identify appropriate testing options. When submitting COVID-19-related claims, follow the coding guidelines and guidance outlined below and review the CDC guideline for ICD-10-CM . Tests must be FDA-authorized. If you have private, employer-sponsored or student health commercial insurance youre eligible to get reimbursed for over-the-counter at-home COVID kits. Our ability to coordinate the availability of COVID-19 testing bolsters states efforts to manage the spread of the virus. In addition, health insurers now provide or reimburse the cost of up to eight home tests per month for most . The new states are Alabama, Arkansas, Colorado, Delaware, Iowa, Mississippi, Montana, North Dakota, Oregon and West Virginia.