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Aetna is waiving member cost-sharing for diagnostic testing related to COVID-19. The test can be done by any authorized testing facility. This member cost-sharing waiver applies to all Commercial, Medicare and Medicaid lines of business. The policy aligns with new Families First legislation and regulations requiring all health plans to provide coverage of COVID-19 testing without cost share. The requirement also applies to self-insured plans. 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 certain serological (antibody) testing with no cost-sharing.
Aetna will cover, without cost share, diagnostic (molecular PCR or antigen) tests to determine the need for member treatment.13 This applies to direct-to-consumer/home-based diagnostic or antigen tests. Aetna’s health plans generally do not cover a tests performed at the direction of a member’s employer in order to obtain or maintain employment or to perform the member’s normal work functions or for return to school or recreational activities, except as required by applicable law.
Aetna will cover, without cost share, serological (antibody) tests that are ordered by a physician or authorized health care professional and are medically necessary. Aetna’s 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 CDC website for the most recent guidance on antibody testing.
This policy for diagnostic and antibody testing applies to Commercial, Medicare and Medicaid plans.14
13 Aetna will follow all federal and state mandates for insured plans, as required.
14 Disclaimer: Regulations regarding testing for Aetna Medicaid members vary by state and, in some cases, may change in light of the current situation. Providers are encouraged to call their provider services representative for additional information.
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. Cost to the member will be determined by each individual health plan.
Yes. 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. The policy aligns with Families First legislation and regulations requiring all health plans to provide coverage of COVID-19 testing without cost share.
An order from an authorized health care professional is required for covered COVID-19 tests for Aetna Commercial and Medicare plans.
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. Pharmacists, in partnership with other health care providers, are well positioned to aid COVID-19 testing expansion.
Routine testing for influenza, strep, and other respiratory infections without a COVID-19 test will be covered subject to applicable cost sharing under the member’s plan.
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. 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.
For Medicare and Commercial plans, the lab tests must be FDA authorized.
Commercial labs are in the process of updating their provider community about their capabilities and how to order tests. National labs will not collect specimens for COVID-19 testing. Instead, an appropriate specimen should be collected at the health care facility where the patient was seen and the test was ordered. The specimen should be sent to these laboratories using standard procedures.
Aetna is reaching out to the commercial labs about their ability to provide the COVID-19 testing. Selected national labs approved to do COVID-19 testing are (information as of May 1, 2020):
There are other participating commercial labs, hospitals and urgent care centers authorized to provide COVID-19 lab testing. For CVS Health testing initiatives, see sections titled, “Rapid test drive-through testing locations” and “COVID-19 Drive-Thru testing at CVS Pharmacy Locations”.
To ensure access for COVID-19 testing and have consistent reimbursement, Aetna will reimburse contracted and non-contracted providers for COVID-19 testing as follows in accordance with the member’s benefit plan:*
Diagnostic testing/handling rates - Medicare
Antibody testing rates - Medicare:
These reimbursement rates for COVID-19 diagnostic and antibody testing are based on rates recently announced by CMS. 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.
* Rates above are not applicable to Aetna Better Health Plans. Aetna Better Health plan pricing may be determined by each individual health plan in accordance with its state contracts.
Aetna is complying with the CMS coding guidelines for COVID-19 lab testing. CMS adopted two CPT codes, (U0001) and (U0002), for COVID-19 testing. Aetna will accept CPT code 87635 or HCPCS Level II U0002 for the COVID-19 testing.
As of right now, there are five rapid testing sites, one each in Connecticut, Georgia, Massachusetts, Michigan and Rhode Island.
Rapid COVID-19 Testing locations:
Drive-through testing, by appointment, will be open seven days a week.
At the end of April, CVS Health set out a goal to establish up to 1,000 locations across the country offering COVID-19 testing by the end of May, with the goal of processing up to 1.5 million tests per month, subject to availability of supplies and lab capacity. Additional locations may be added in the coming months.
Our pharmacies and MinuteClinics are uniquely positioned to help address the pandemic and protect people’s health. Building on the company’s comprehensive efforts to help slow the spread of the virus, we can bring safe and effective testing options closer to home and help increase access to testing options for even more individuals. This allows us to continue to help slow the spread of the virus.
Testing will not be available at all CVS Pharmacy locations. Testing will not take place inside any retail locations, and CVS Pharmacy, HealthHUB and MinuteClinic will continue to serve customers and patients.
CVS Health has established more than 1,000 locations across the country offering COVID-19 testing, with the goal of processing up to 1.5 million tests per month, subject to availability of supplies and lab capacity. Through this effort we are hoping to provide additional access in areas of the country that need additional testing and are selecting CVS Pharmacy locations with this criteria in mind.
Each site should have the capacity to conduct approximately 50 tests per day.
Yes, patients must register in advance at CVS.com to schedule an appointment. Patients will need to pre-register, provide their insurance information as appropriate and verify their eligibility for testing. Once they have registered, the patient will be provided with an appointment window for that same day or up to two days out.
Yes, first responders and health care workers will be able to sign up if their local or state health departments have prioritized these groups for testing, if they have a physician’s referral, or if they are symptomatic.
Aetna will waive member cost-sharing for inpatient admissions for treatment of COVID-19 or health complications associated with COVID-19. This policy applies to all Aetna-insured Commercial and Medicare Advantage plans and is effective immediately for any such admission through September 30, 2020. Self-insured plan sponsors offer this waiver at their discretion.
Yes, Aetna will cover the cost for treatment of COVID-19 for our Medicare Advantage members in full in the provider office. We will also cover the cost of the hospital stay for all of our Medicare Advantage members admitted March 25, 2020 through September 30, 2020.
Regulations regarding cost-sharing for Medicaid beneficiaries vary by state and continue to evolve in light of the current situation. We have suspended cost-sharing requirements, including premiums and copays, for adults and children covered by Medicaid and CHIP, in those states where permitted to do so by the appropriate regulators.
This change was effective March 25, 2020 and will apply to any such inpatient admission or health complications associated with COVID-19 through September 30, 2020.
All claims received for Aetna-insured members going forward will be processed based on this new policy. 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. In the event a claim has already been processed prior to this policy going into effect, members should contact Customer Service so the claim can be reprocessed accordingly.
No, Aetna will pay the amount of the cost-sharing the member would have ordinarily paid so the provider would receive the same total payment.
Yes. During the COVID-19 pandemic, Aetna will pay for emergency care at the in-network level regardless of the location.
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