Note: Each test is counted separately even if multiple tests are sold in a single package. If your reimbursement request is approved, a check will be mailed to you. Patrick T. Fallon/AFP/Getty Images via Bloomberg. At-home COVID-19 tests are excluded from all coupon discounts and promotions, including CarePass and ExtraBucks Rewards . 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 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. The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. Aetna will cover, without cost share, serological (antibody) tests that are ordered by a physician or authorized health care professional and are 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. 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. 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. Coverage is in effect, per the mandate, until the end of the federal public health emergency. This waiver may remain in place in states where mandated. 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). 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). This also applies to Medicare and Medicaid plan coverage. On average, the test results are typically available within 1-2 days, but may take longer due to local surges in COVID-19. You may opt out at any time. Starting Saturday, private health plans are required to cover . Once they have registered, the patient will be provided with an appointment window forup to seven days in advance. Tests must be approved, cleared or authorized by the. Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept". For more information on what tests are eligible for reimbursement, visit OptumRx's website. For more information about the virus, please visit the CDC and/or WHO websites dedicated to this issue. 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. This includes the testing only not necessarily the Physician visit. You can also use it to pay for medical, dental and vision bills, including telehealth and COVID-19 treatment. If you have health coverage through Cigna, you will need to print and fill out this at-home COVID-19 test reimbursement form. 2020 claims eligible for the 20% increase in the MS-DRG weighting factor will also be required to have a . 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. This applies whether you purchased your health . Those using a non-CDC test will be reimbursed $51 . 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. Health benefits and health insurance plans contain exclusions and limitations. 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. Be sure to check your email for periodic updates. Testing will not be available at all CVS Pharmacy locations. This allows us to continue to help slow the spread of the virus. These reimbursement rates for COVID-19 diagnostic and antibody testing are based on rates announced by CMS. 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. Recently, the United States government made available four free at-home COVID-19 tests to each home address upon request. The American Medical Association (AMA) does not directly or indirectly practice medicine or dispense medical services. Aetna will cover treatment of COVID-19 for our Medicare Advantage members. When you submit your claim, youll need to include: Youll also be asked to attest that the OTC kit is for personal use only, and not for employment, school, recreational or travel purposes. Please be sure to add a 1 before your mobile number, ex: 19876543210. Members should discuss any matters related to their coverage or condition with their treating provider. Claims for reimbursement for at home COVID-19 tests may be submitted online or via mail using the printable form. Postal Service. Under certain plans, if more than one service can be used to treat a covered person's dental condition, Aetna may decide to authorize coverage only for a less costly covered service provided that certain terms are met. 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. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. Members should take their red, white and blue Medicare card when they pick up their tests. This Agreement will terminate upon notice if you violate its terms. 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. When billing, you must use the most appropriate code as of the effective date of the submission. It doesnt need a doctors order. Members should discuss any Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider. Lab-based PCR home collection kits are not covered at this time by the OTC kit mandate. You can also call Aetna Member Services by . 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. The member's benefit plan determines coverage. 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. Your employer or health plan will have the best information on how to buy OTC COVID-19 tests that will be covered. Members will need to submit a claim for reimbursement through the Aetna website and will receive a check once the claim is approved. A list of approved tests is available from the U.S. Food & Drug Administration. 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. 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. Note: Each test is counted separately even if multiple tests are sold in a single package. 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. They may also order up to two sets of four at-home tests per household by visiting COVIDtests.gov. 1Aetna will follow all federal and state mandates for insured plans, as required. This information is neither an offer of coverage nor medical advice. 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). Important: Use your Aetna ID that starts with a "W.". Tests must be FDA authorized in accordance with the requirements of the CARES Act. Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. Any test ordered by your physician is covered by your insurance plan. If your pharmacy benefits are not with Aetna, contact your pharmacy benefits administrator for instructions. CVS Health currently has more than 4,800 locations across the country offering COVID-19 testing. 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. Kaiser members can go to " Coverage & Costs " and select "Submit a medical claim.". Medicare covered OTC COVID tests are provided by participating providers and pharmacies. Your benefits plan determines coverage. *The content below is not intended to be a substitute for professional medical advice, diagnosis or treatment. 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. Sign in or register at Caremark.com (You must be a CVS Caremark member) Please call your medical benefits administrator for your testing coverage details. A BinaxNow test shows a negative result for COVID-19. Yes, patients must register in advance at CVS.com to schedule an appointment. New and revised codes are added to the CPBs as they are updated. 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. 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. Treating providers are solely responsible for medical advice and treatment of members. Building on the companys comprehensive efforts to help slow the spread of the virus, we can bring safe and effective testingoptions closer to home and help increase access to testing options for even more individuals. The tests, part of the administration's purchase of 500 million tests last . Treating providers are solely responsible for medical advice and treatment of members. Even if the person gives you a different number, do not call it. All services deemed "never effective" are excluded from coverage. 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. 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. 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. Note: Each test is counted separately even if multiple tests are sold in a single package. 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. Cigna. 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. You wont be able to get reimbursed for tests* that: * May be subject to state-specific COVID-19 coverage mandates. 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. This member cost-sharing waiver applies to all Commercial, Medicare and Medicaid lines of business. You can find a partial list of participating pharmacies at Medicare.gov. It is only a partial, general description of plan or program benefits and does not constitute a contract. 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 member's benefit plan determines coverage. 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". Tests must be approved, cleared or authorized by the. CPT is a registered trademark of the American Medical Association. Stay up to date and find state resources, like testing sites, updated case counts, facts from the Centers for Disease Control and more. On March 16, the CMS released details about how COVID-19 testing would be reimbursed to health care providers administering the tests. If the plan provides in and out of network coverage, then the cost-sharing waiver applies to testing performed or ordered by in-network or out-of-network providers.