The COVID-19 At-Home Test Reimbursement form is 1 page long and contains: 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. Tests must be purchased on or after January 15, 2022. 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. 7/31/2021. Tests must be used to diagnose a potential COVID-19 infection. Treating providers are solely responsible for medical advice and treatment of members. 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. 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. 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. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. This excerpt is provided for use in connection with the review of a claim for benefits and may not be reproduced or used for any other purpose. Insurance companies are still figuring out the best system to do . 12/03/2021 05:02 PM EST. There are two main ways to purchase these tests. If your reimbursement request is approved, a check will be mailed to you. 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. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Aetna will cover, without cost share, serological (antibody) tests that are ordered by a physician or authorized health care professional and are medically necessary. The member's benefit plan determines coverage. If your reimbursement request is approved, a check will be mailed to you. HCPCS code. A list of approved tests is available from the U.S. Food & Drug Administration. Testing will not be available at all CVS Pharmacy locations. Print the form and fill it out completely. The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. Commercial labs are in the process of updating their provider community about their capabilities and how to order tests. Note: Each test is counted separately even if multiple tests are sold in a single package. Yes, patients must register in advance at CVS.comto schedule an appointment. No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM. . Members should take their red, white and blue Medicare card when they pick up their tests. If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. 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. 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. This policy for diagnostic and antibody testing applies to Commercial, Medicare and Medicaid plans.2. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. Your commercial plan will reimburse you up to $12 per test. On average this form takes 13 minutes to complete. The site said more information on how members can submit claims will soon be available. The requirement also applies to self-insured plans. Reimbursement for using the CDC 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Panel. $35.92. The test can be done by any authorized testing facility. Home test kits may be eligible for reimbursement through OptumRx if the test was purchased after January 15, 2022. Please refer to the FDA and CDC websites for the most up-to-date information. Refer to the U.S. Food & Drug Administration on tests that are eligible for coverage. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. Others have four tiers, three tiers or two tiers. Unlisted, unspecified and nonspecific codes should be avoided. There is no obligation to enroll. 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. 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. 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. 1 This applies to Medicare, Medicaid, and private insurers. COVID-19 At-Home Test Reimbursement. This pilot provided the company with a number of key learnings, which helped inform the companys ability to improve on and maximize drive-through testing for consumers. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. This mandate is in effect until the end of the federal public health emergency. 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. 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). This is all part of our overall strategy to ramp-up access to easy-to-use, at-home tests at no cost," said U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra, in a . This member cost-sharing waiver applies to all Commercial, Medicare and Medicaid lines of business. For example, Binax offers a package with two tests that would count as two individual tests. For more information on test site locations in a specific state visit CVS. 1Aetna will follow all federal and state mandates for insured plans, as required. GC-1664-3 (12-22) Aetna Medicare Page 1 of 3 R-POD C Member information (print clearly) Medicare Medical Claim Reimbursement Form Aetna member ID: Date of birth (MM/DD/YYYY): Male Female (If you prefer not to disclose, leave blank) Last name: First name: Middle initial: Street address: City: The policy . Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search. The tests were shipped through the U.S. If you are not on UHART's . Rates may vary for Commercial Plans based on factors such as billed charges or contractual terms. Yes. Aetna members can now receive reimbursement for test kits purchased on or after Jan. 15, 2022. The requirement also applies to self-insured plans. This information is available on the HRSA website. 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). Some plans exclude coverage for services or supplies that Aetna considers medically necessary. You can find a partial list of participating pharmacies at Medicare.gov. On March 16, the CMS released details about how COVID-19 testing would be reimbursed to health care providers administering the tests. Yes. Covers up to eight (8) rapid antigen single-test kits or four (4) rapid antigen two-test kits per month. 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. Coverage is in effect, per the mandate, until the end of the federal public health emergency. For more information about the virus, please visit the CDC and/or WHO websites dedicated to this issue. 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. Just enter your mobile number and well text you a link to download the Aetna Health app from the App Store or on Google Play. Members should discuss any matters related to their coverage or condition with their treating provider. The member's benefit plan determines coverage. In addition, health insurers now provide or reimburse the cost of up to eight home tests per month for most . CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to the implied warranties of merchantability and fitness for a particular purpose. 2Disclaimer: Regulations regarding testing for Aetna Medicaid members vary by state and, in some cases, may change in light of the current situation. Save your COVID-19 test purchase receipts. Stay up to date and find state resources, like testing sites, updated case counts, facts from the Centers for Disease Control and more. The member's benefit plan determines coverage. This includes those enrolled in a Medicare Advantage plan. Patrick T. Fallon/AFP/Getty Images via Bloomberg. You can continue to use your HSA even if you lose your job. Since Dental Clinical Policy Bulletins (DCPBs) 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. 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. You can find a partial list of participating pharmacies at Medicare.gov. Learn more here. Note: Each test is counted separately even if multiple tests are sold in a single package. 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.
