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. Last update: February 1, 2023, 4:30 p.m. CT. When submitting COVID-19-related claims, follow the coding guidelines and guidance outlined below and review the CDC guideline for ICD-10-CM . 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. This search will use the five-tier subtype. Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". Over-the-counter (OTC) COVID-19 at home test kits - Aetna Feds 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. Please log in to your secure account to get what you need. Why Getting Reimbursed for Covid Tests Is a Pain in the Ass - Vice Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. Treating providers are solely responsible for medical advice and treatment of members. The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. In addition, coverage may be mandated by applicable legal requirements of a State or the Federal government. Aetna members can now receive reimbursement for test kits purchased on or after Jan. 15, 2022. 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. Do you want to continue? 2Disclaimer: Regulations regarding testing for Aetna Medicaid members vary by state and, in some cases, may change in light of the current situation. Aetna Medicare plans do not reimburse for OTC COVID-19 tests. 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. By submitting a claim to Aetna for COVID-19 testing, providers acknowledge that the above amounts will be accepted as payment in full for each COVID-19 test performed, and that they will not seek additional reimbursement from members. CPT is a registered trademark of the American Medical Association. 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 . Medicare covers the updated COVID-19 vaccine at no cost to you. Children age 3 years and older are now eligible for testing at all of our COVID-19 drive-thru and rapid-result testing sites located at select CVS Pharmacy locations, effective March 5, 2021. 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. 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. You pay nothing for a diagnostic test during the COVID-19 public health emergency when you get it from a laboratory, pharmacy, doctor, or hospital, and when Medicare covers this test in your local area. 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 . 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). 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. For more information on test site locations in a specific state, please visit CVS.com. 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 test can be done by any authorized testing facility. COVID-19 At-Home Test Reimbursement. 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 . You, your employees and agents are authorized to use CPT only as contained in Aetna Clinical Policy Bulletins (CPBs) solely for your own personal use in directly participating in healthcare programs administered by Aetna, Inc. You acknowledge that AMA holds all copyright, trademark and other rights in CPT. Providers will bill Medicare. These reimbursement rates for COVID-19 diagnostic and antibody testing are based on rates announced by CMS. U0002. 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. Detect Covid-19 test. Recently, the United States government made available four free at-home COVID-19 tests to each home address upon request. Please note that copays, deductibles and coinsurance will apply according to the members benefit plan. Yes. COVID-19: Billing & Coding FAQs for Aetna Providers Kaiser members can go to " Coverage & Costs " and select "Submit a medical claim.". 7/31/2021. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. 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 . *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. Rates may vary for Commercial Plans based on factors such as billed charges or contractual terms. 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. Any COVID-19 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. The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. 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 Better Health members with questions about these specific benefits are encouraged to call the member services phone number on the back of their ID cards. 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. CPT only copyright 2015 American Medical Association. Some subtypes have five tiers of coverage. You wont be able to get reimbursed for tests* that: * May be subject to state-specific COVID-19 coverage mandates. Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. 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. 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. 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. How to get insurance to pay reimbursement for COVID tests | Crain's Medicare now covers up to 8 over-the-counter COVID-19 tests each calendar month, at no cost to you. Yes. 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 don't see your testing and treatment questions here, let us know. If your reimbursement request is approved, a check will be mailed to you. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. 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. The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. Aetna is reaching out to the commercial labs about their ability to provide the COVID-19 testing. 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). If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. If your pharmacy benefits are not with Aetna, contact your pharmacy benefits administrator for instructions. 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. 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". Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Are Medicare Advantage Insurers Covering the Cost of At-Home COVID-19 No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Home Test Kit Reimbursement. Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. Cigna. 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. 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 . 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. Health insurance covers at-home COVID-19 tests | Consumer Advice