If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. CPT is a registered trademark of the American Medical Association. 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. 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. 1Aetna will follow all federal and state mandates for insured plans, as required. Links to various non-Aetna sites are provided for your convenience only. 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. Learn more here. This does not apply to Medicare. There is no obligation to enroll. Aetna members can now receive reimbursement for test kits purchased on or after Jan. 15, 2022. Each main plan type has more than one subtype. This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. If you do not intend to leave our site, close this message. CVS Pharmacy, HealthHUB and MinuteClinic will continue to serve customers and patients. 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. Claims for reimbursement for at home COVID-19 tests may be submitted online or via mail using the printable form. At this time, covered tests are not subject to frequency limitations. Treating providers are solely responsible for dental advice and treatment of members. Complete this form for each covered member. 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). reimbursement scheme relies on people being able to find rapid COVID tests to buy either online or at their local pharmacy. This requirement will continue as long as the COVID public health emergency lasts. Our ability to coordinate the availability of COVID-19 testing bolsters states efforts to manage the spread of the virus. During the COVID-19 PHE, get one lab-performed test without a health care professional's order, at no cost. The American Medical Association (AMA) does not directly or indirectly practice medicine or dispense medical services. 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. Aetna will cover, without cost share, serological (antibody) tests that are ordered by a physician or authorized health care professional and are medically necessary. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. 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. 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. Each site operated seven days a week, providing results to patients on-site, through the end of June. 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. Treating providers are solely responsible for medical advice and treatment of members. 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 responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. Aetna is complying with the CMS coding guidelines for COVID-19 lab testing. Members should discuss any matters related to their coverage or condition with their treating provider. 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. This search will use the five-tier subtype. Your plan may require reasonable documentation of proof of purchase with a claim for reimbursement for the cost of an OTC COVID-19 test. Since January 2022, health insurance plans have been required to cover the cost of at-home rapid tests for COVID-19. Those who have already purchased . It doesnt need a doctors order. Each main plan type has more than one subtype. Treating providers are solely responsible for medical advice and treatment of members. Self-insured plan sponsors offered this waiver at their discretion. 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. For example, Binax offers a package with two tests that would count as two individual tests. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. ", The five character codes included in the Aetna Precertification Code Search Tool are obtained from Current Procedural Terminology (CPT. Sign in or register at Caremark.com (You must be a CVS Caremark member) Applicable FARS/DFARS apply. Members should take their red, white and blue Medicare card when they pick up their tests. All claims received for Aetna-insured members going forward will be processed based on this new policy. Box 981106, El Paso, TX 79998-1106. Aetna Better Health plan pricing may be determined by each individual health plan in accordance with its state contracts. 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 March, CVS Health opened a pilot drive-through COVID-19 test site in a parking lot at a CVS Pharmacy store in Shrewsbury, MA. Note: Each test is counted separately even if multiple tests are sold in a single package. 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 . This waiver may remain in place in states where mandated. As for the eight-test maximum, a family of four covered under the same plan could be reimbursed for up to 32 tests per 30-day period. 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 . Your employer or health plan will have the best information on how to buy OTC COVID-19 tests that will be covered. However, you will likely be asked to scan a copy of . 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. 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. This mandate is in effect until the end of the federal public health emergency. 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. Home test kits may be eligible for reimbursement through OptumRx if the test was purchased after January 15, 2022. The AMA is a third party beneficiary to this Agreement. LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). 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. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. Yes. Get the latest updates on every aspect of the pandemic. 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. This benefit does not apply to Aetna Better Heath of New York, since medical benefits are not covered. The reality may be far different, adding hurdles for . Medicare now covers up to 8 over-the-counter COVID-19 tests each calendar month, at no cost to you. 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). 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. 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. Aetna updated its website Friday with new frequently asked questions about the new requirement. Tests must be FDA authorized in accordance with the requirements of the CARES Act. 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. 7/31/2021. 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.