Send it to the address shown on the form. 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: It is only a partial, general description of plan or program benefits and does not constitute a contract. Complete this form for each covered member. 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. Aetna Medicare members can obtain OTC COVID-19 tests from participating providers and pharmacies, but will not be reimbursed for self-purchased tests. If you have private, employer-sponsored or student health commercial insurance youre eligible to get reimbursed for over-the-counter at-home COVID kits. The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. Some pharmacies may not be able to process claims for OTC COVID-19 tests at the pharmacy counter. Please note also that Dental Clinical Policy Bulletins (DCPBs) are regularly updated and are therefore subject to change. 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. Coverage is in effect, per the mandate, until the end of the federal public health emergency. 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. If you do not intend to leave our site, close this message. 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. Aetna is complying with the CMS coding guidelines for COVID-19 lab testing. For all Aetna-insured Commercial plans, Aetna waived member cost-sharing for inpatient admissions for treatment of COVID-19 or health complications associated with COVID-19 through February 28, 2021. Recently, the United States government made available four free at-home COVID-19 tests to each home address upon request. It is only a partial, general description of plan or program benefits and does not constitute a contract. Members should take their red, white and blue Medicare card when they pick up their tests. Americans with health insurance can get up to eight at-home coronavirus tests for free thanks to a new requirement. Yes, patients must register in advance at CVS.comto schedule an appointment. For language services, please call the number on your member ID card and request an operator. All forms are printable and downloadable. CPT is a registered trademark of the American Medical Association. 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. Thanks! Any test ordered by your physician is covered by your insurance plan. Reimbursement for using the CDC 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Panel. CPT is a registered trademark of the American Medical Association. 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. COVID-19 testing, vaccines, hospitalizations and related expenses will return to the standard coverage for in-network and out of network services. By clicking on I accept, I acknowledge and accept that: Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". Testing, coding and reimbursement protocols and guidelines are established based on guidance from the Centers for Medicare & Medicaid Services (CMS), the Centers for Disease Control and Prevention (CDC), state and federal governments and other . 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. Blue Shield of California, Care First, Cigna, CVS Group/Aetna, and Kaiser Permanente) are currently relying only on reimbursement . COVID-19 home test kit returns will not be accepted. Please note: Your receipt must be dated January 15, 2022 or later to be eligible for reimbursement. You can use this money to pay for HSA eligible products. Postal Service will ship the tests directly to your door free of charge. 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. Reimbursement for 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV testing using any technique multiple types, subtypes (includes all targets) Reimbursement. This member cost-sharing waiver applies to all Commercial, Medicare and Medicaid lines of business. This benefit does not apply to Aetna Better Heath of New York, since medical benefits are not covered. Stay up to date and find state resources, like testing sites, updated case counts, facts from the Centers for Disease Control and more. 4. The U.S. 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. Yes. Care providers are responsible for submitting accurate claims in accordance with state and federal laws and UnitedHealthcare's reimbursement policies. 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. 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: Medicare covered OTC COVID tests are provided by participating providers and pharmacies. Any COVID-19 test ordered by your physician is covered by your insurance plan. Self-insured plan sponsors offered this waiver at their discretion. This member cost-sharing waiver applies to all Commercial, Medicare and Medicaid lines of business. If in-patient treatment was required for a member with a positive COVID-19 diagnosis prior to this announcement it will be processed in accordance with this new policy. Any test ordered by your physician is covered by your insurance plan. Our ability to coordinate the availability of COVID-19 testing bolsters states efforts to manage the spread of the virus. Please report any scams by calling 1-800-447-8477 or online at https://tips.oig.hhs.gov/. 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. Claim Coding, Submissions and Reimbursement. Unlisted, unspecified and nonspecific codes should be avoided. 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). HCPCS code. Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). Others have four tiers, three tiers or two tiers. Description. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Who the tests are for (self or dependent), Your pharmacy plan should be able to provide that information. Who the tests are for (self or dependent), Your pharmacy plan should be able to provide that information. The ABA Medical Necessity Guidedoes not constitute medical advice. 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 . Tests must be FDA-authorized. Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. Links to various non-Aetna sites are provided for your convenience only. Although the federal government is not providing free tests at this time, it has taken steps to ensure that people are able to get free tests through their health insurance - Medicare included. While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. For CVS Health testing initiatives, see section titled, COVID-19 drive-thru testing at CVS Pharmacy locations. The Biden administration will launch a website where Americans can order free coronavirus tests on Jan. 19.. 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. In case of a conflict between your plan documents and this information, the plan documents will govern. Also, new federal guidelines allow members with private, employer-sponsored and student health commercial insurance to request reimbursement for over-the-counter COVID-19 diagnostic tests that are purchased on or after January 15, 2022 without physician's orders 1 . 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. Unlisted, unspecified and nonspecific codes should be avoided. For more information and future updates, visit the CMS website and its newsroom. Testing will not be available at all CVS Pharmacy locations. For more information on test site locations in a specific state visit CVS. National labs will not collect specimens for COVID-19 testing. 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. 7/31/2021. A BinaxNow test shows a negative result for COVID-19. Members should take their red, white and blue Medicare card when they pick up their tests. 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. Lab-based PCR home collection kits are not covered at this time by the OTC kit mandate. This applies whether you purchased your health . 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. 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. This includes those enrolled in a Medicare Advantage plan. On March 16, the CMS released details about how COVID-19 testing would be reimbursed to health care providers administering the tests. CVS Health currently has more than 4,800 drive thru testing locations across the country offering COVID-19 testing. Aetna is in the process of developing a direct-to-consumer shipping option. Links to various non-Aetna sites are provided for your convenience only. Members should take their red, white and blue Medicare card when they pick up their tests. 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). Access trusted resources about COVID-19, including vaccine updates. 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. Tests must be FDA authorized in accordance with the requirements of the CARES Act. Last update: February 1, 2023, 4:30 p.m. CT. The AMA is a third party beneficiary to this Agreement. Members must get them from participating pharmacies and health care providers. 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. Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. 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. New and revised codes are added to the CPBs as they are updated. Refer to the U.S. Food & Drug Administration on tests that are eligible for coverage. The discussion, analysis, conclusions and positions reflected in the Clinical Policy Bulletins (CPBs), including any reference to a specific provider, product, process or service by name, trademark, manufacturer, constitute Aetna's opinion and are made without any intent to defame. 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. 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 . While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. Learn more about what's covered and what you need to do to get reimbursed, and get answers to other frequently asked questions about at-home COVID-19 self-test coverage. As the insurer Aetna says . 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 the time being, you'll have to submit a claim to get reimbursed after you buy tests. 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. Please note that copays, deductibles and coinsurance will apply according to the members benefit plan. In addition, coverage may be mandated by applicable legal requirements of a State or the Federal government. All telehealth/telemedicine, which includes all medical and behavioral health care . Also, new federal guidelines allow members with private, employer-sponsored and student health commercial insurance to request reimbursement for over-the-counter COVID-19 diagnostic tests that are purchased on or after January 15, 2022 without physicians orders1. The following rates are used for COVID-19 testing for commercial and Medicare plans, unless noted otherwise: Diagnostic testing/handling rates - Medicare. All Rights Reserved. This Agreement will terminate upon notice if you violate its terms. Any test ordered by your physician is covered by your insurance plan. There are two main ways to purchase these tests. Click on the COVID-19 Home Test Reimbursement Form link. This waiver may remain in place in states where mandated. For all Aetna-insured Commercial plans, Aetna waived member cost-sharing for inpatient admissions for treatment of COVID-19 or health complications associated with COVID-19 through February 28, 2021. The policy . Please note that copays, deductibles and coinsurance will apply according to the members benefit plan. CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. Of note: Aetna specifies that "tests must be used to diagnose a potential Covid-19 infection" and tests used for employment, school or recreational purposes aren't eligible for reimbursement. Referrals from University Health Services for off-campus medical care will again be required. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. 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. Box 981106, El Paso, TX 79998-1106. 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. You can continue to use your HSA even if you lose your job. 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. Now, however, anyone in the U.S. can order a total of four free tests per household via COVIDtests.gov. 1 This applies to Medicare, Medicaid, and private insurers. Access trusted resources about COVID-19, including vaccine updates. Effective April 4, 2022, Medicare will cover up to eight (8) at-home COVID-19 tests per person every 30 days or four (4) two-test, rapid antigen at-home tests every 30 days without a prescription. Each main plan type has more than one subtype. The site said more information on how members can submit claims will soon be available. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Members should discuss any Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider. Sign in or register at Caremark.com (You must be a CVS Caremark member) . The information contained in this FAQ is subject to change at the discretion of CVS at any time, for any reason and without advanced notice. 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. Refer to the U.S. Food & Drug Administration on tests that are eligible for coverage. Call 1-800-Medicare (1-800-633-4227) with any questions about this initiative. 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. For example, some UnitedHealthcare plans cover up to $40 of OTC products per quarter, which would cover the cost of 3 COVID-19 tests every 3 months (based on the $12 reimbursement rate being used . Beginning January 15, 2022, individuals with private health insurance coverage or covered by a group health plan who purchase an over-the-counter COVID-19 diagnostic test authorized, cleared, or approved by the U.S. Food and Drug Administration (FDA) will be able to have those test costs covered by their plan or insurance. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. Note: Each test is counted separately even if multiple tests are sold in a single package. If this happens, you can pay for the test, then submit a request for reimbursement. At this time, covered tests are not subject to frequency limitations. 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. Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. Applicable FARS/DFARS apply. Any test ordered by your physician is covered by your insurance plan. If this happens, you can pay for the test, then submit a request for reimbursement. A list of approved tests is available from the U.S. Food & Drug Administration. 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). This does not apply to Medicare. 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. If you have health coverage through Cigna, you will need to print and fill out this at-home COVID-19 test reimbursement form. Aetna is working to protect you from COVID-19 scams. Medicare covers the vaccine for anyone who has Medicare due to their age, a disability, End-Stage Renal Disease (ESRD), or ALS (also called . 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. Aetna Better Health plan pricing may be determined by each individual health plan in accordance with its state contracts. As omicron has soared, the tests' availability seems to have plummeted. LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). Also, new federal guidelines allow members with private, employer-sponsored and student health commercial insurance to request reimbursement for over-the-counter COVID-19 diagnostic tests that are purchased on or after January 15, 2022 without physicians orders1. The information you will be accessing is provided by another organization or vendor. Please call your medical benefits administrator for your testing coverage details. Yes, Aetna will cover tests approved, cleared or authorized by the U.S. Food and Drug Administration. You are now being directed to the CVS Health site. 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. CVS Pharmacy, HealthHUB and MinuteClinic will continue to serve customers and patients. The tests, part of the administration's purchase of 500 million tests last . This requirement will continue as long as the COVID public health emergency lasts. Tests used for employment, school or recreational purposes are not eligible for reimbursement unless required by state law. Providers are encouraged to call their provider services representative for additional information. Detect Covid-19 test. Please refer to the FDA and CDC websites for the most up-to-date information. . Reprinted with permission. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. CVS Pharmacy, HealthHUB and MinuteClinic will continue to serve customers and patients. Do you want to continue? If you are not on UHART's . 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. 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 . Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept". 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. CPT is a registered trademark of the American Medical Association. Subject to applicable law, Aetna may deny tests that do not meet medical necessity criteria. The tests were shipped through the U.S. 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. 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. This information is available on the HRSA website. *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. Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. 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. Yes. 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. Tests must be used to diagnose a potential COVID-19 infection. Tests used for employment, school or recreational purposes are not eligible for reimbursement unless required by state law. Note: Each test is counted separately even if multiple tests are sold in a single package. Please log in to your secure account to get what you need. Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. If you're on Medicare, there's also a . For more information, see the attached Guidance for COVID-19 OTC Testing Coverage. Each main plan type has more than one subtype. They should check to see which ones are participating. You can also use it to pay for medical, dental and vision bills, including telehealth and COVID-19 treatment. You wont be able to get reimbursed for tests* that: * May be subject to state-specific COVID-19 coverage mandates. This mandate is in effect until the end of the federal public health emergency. Consumers who are fortunate enough to get their hands on over-the-counter, rapid COVID-19 tests will soon be reimbursed by their insurers for the cost of such devices under new . $35.92. . Your benefits plan determines coverage. License to sue 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. Aetna is reaching out to the commercial labs about their ability to provide the COVID-19 testing. Get a COVID-19 vaccine as soon as you can. You are now being directed to the CVS Health site. (Offer to transfer member to their PBMs customer service team.). 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.

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