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. CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. All Rights Reserved. Aetna members have access to contact information and resources specific to their plans. Your benefits plan determines coverage. 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. 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. I may or may not be employed by an Aetna-contracted provider. Froma24-hour nurse line to vision and fitness, youre covered. This information is neither an offer of coverage nor medical advice. If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. It's on demand care, wherever you need it. The American Medical Association (AMA) does not directly or indirectly practice medicine or dispense medical services. When billing, you must use the most appropriate code as of the effective date of the submission. While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. Some subtypes have five tiers of coverage. CPT is a registered trademark of the American Medical Association. 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. If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. Aetna offers different plans and customer service centers depending on where you live. You, your employees and agents are authorized to use CPT only as contained in Aetna Precertification Code Search Tool solely for your own personal use in directly participating in health care programs administered by Aetna, Inc. You acknowledge that AMA holds all copyright, trademark and other rights in CPT. Aetna and MinuteClinic, LLC (which either operates or provides certain management support services to MinuteClinic-branded walk-in clinics) are part of the CVS Health family of companies. WebContact Aetna Get the answers you need here If you have questions related to COVID-19, including those on our telemedicine policy, testing, coding for COVID-19 related visits, and additional resources Aetna is sharing to support you during this pandemic, please check our Provider COVID-19 FAQ website. The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. [Narrator] It's care on your schedule at your convenience. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. ", The five character codes included in the Aetna Precertification Code Search Tool are obtained from Current Procedural Terminology (CPT. 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). If you do not intend to leave Aetna Medicare, close this message. Torequest participation in First Health networks, follow the link below. The member's benefit plan determines coverage. Aetna is performing an automated outbound call to health exchange members who have coverage through Aetna. This search will use the five-tier subtype. 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 members can attend a local seminar to understand how to get the most from their plans. Treating providers are solely responsible for medical advice and treatment of members. LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). You are leaving our Medicare website and going to our non-Medicare website. Treating providers are solely responsible for medical advice and treatment of members. Do you want to continue? [Virtual care professional] I'm really glad that you reached out. 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. Well, for starters, it means you'll have more options for care. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Do you want to continue? [Mom] I feel so much relief. [Narrator] Virtual care, telehealth, you've probably heard of them, but what does it really mean for you? 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. We know insurance is confusing and you have questions. Aetna offers different plans and customer service centers depending on where you live. Well, for starters it means you'll have more options for care. Links to various non-Aetna sites are provided for your convenience only. I understand that I am not required to provide this consent as a condition of purchase or receiving insurance and that my consent can be revoked at any time. They do not have access to member accounts but they can provide Aetna Member Services contact information. 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. Why choose ${company} Medicare Solutions? You are now being directed to CVS Caremark site. 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. ", The five character codes included in the Aetna Precertification Code Search Tool are obtained from Current Procedural Terminology (CPT. Applicable FARS/DFARS apply. Medicare Advantage andPrescription Drug Plans, 1-800-307-4830(TTY: 711), 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 discuss any Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider. Dual Eligible Special Needs Plans (D-SNP). Please log in to your secure account to get what you need. 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. Please log in to your secure account to get what you need. The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. 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. Copyright 2015 by the American Society of Addiction Medicine. 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. Medicare coverage for the whole you body, mind and spirit, Discover coverage that takes a total approach to health, See how we help you get the right resources and care, Take full advantage of everything your plan offers you. Credentialing and joining our network - 1-800-353-1232 (TTY: 711). To collect health assessment and lifestyle survey data. Plan features and availability may vary by service area. Im turning 65 or just starting to explore Medicare. CPT is a registered trademark of the American Medical Association. 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). 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. 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. Go to the American Medical Association Web site. Your InstaMed log in may be different from your Caremark.com secure member site log in. Do not give out your Aetna member ID number or other personal information. [Narrator] Our quality providers are here for you 24/7/365. We've got your back. For language services, please call the number on your member ID card and request an operator. 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. 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. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). Your benefits plan determines coverage. CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. 1-866-235-5660${tty} If youd like to learn more about Aetna Medicare plans, explore our product page for detailed information. Applicable FARS/DFARS apply. You can get convenient and affordable care from wherever you need it. This is the phone number for the Corporate Contact Center. Why choose ${company} Medicare Solutions? Note: If you are a hospital based provider seeking to join an already contracted group, you do not need to complete the application independently. It is only a partial, general description of plan or program benefits and does not constitute a contract. Links to various non-Aetna sites are provided for your convenience only. Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. 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. The member's benefit plan determines coverage. Applicable FARS/DFARS apply. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. 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. 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. When billing, you must use the most appropriate code as of the effective date of the submission. Caremark.com is the secure website where Aetna Medicare SilverScript members can manage prescriptions, sign up for mail delivery, view order status, find drug pricing, and identify savings options. Or simply go to our Get Started page. [Narrator] And you'll get support for more than just your physical health. The AMA is a third party beneficiary to this Agreement. Whether you need help managing your chronic condition, or are looking to schedule a wellness visit, CVS Health Virtual Primary Care makes it simple. We received your request, and well get back to you shortly. Health information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professional. For language services, please call the number on your member ID card and request an operator. CPT is a registered trademark of the American Medical Association. In addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members. The Appointment of Representative form is on CMS.gov. 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 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. Want to see options for a different location? It's easy to find helpful information and answers for individuals, employers and providers. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Send us an email and well get back to you as soon as possible. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. 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. 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. 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. Apple, the Apple logo, iPhone and Apple Watch are trademarks of Apple Inc., registered in the U.S. and other countries. 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. Do you want to continue? Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. 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. The phone number that is part of this call campaign is: 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). 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. 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. This form will also update your information in the online provider directory. 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. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. *MinuteClinic in-person services are not included with this product and are subject to plan benefit. 3. 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. Unlisted, unspecified and nonspecific codes should be avoided. These calls can be spoofed so they look like theyre coming from Medicare even when theyre not. It will show you whether a drug is covered or not covered, but the tier information may not be the same as it is for your specific plan. In Pennsylvania, where competition is fierce, there are over 2.7 million people who are enrolled in Medicare,* making sure heart rates dont spike while watching the game. I understand that I am not required to provide this consent as a condition of purchase or receiving insurance and that my consent can be revoked at any time. 1-855-335-1407 (TTY: 711), 7 days a week, 8 AM to 8 PM. Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. Copyright 2015 by the American Society of Addiction Medicine. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. I consent to receive autodialed marketing calls from or on behalf of Aetna about health insurance. No fee schedules, basic unit, relative values or related listings are included in CPT. Applicable FARS/DFARS apply. Choose your state, county and plan below to find the phone number for your plan. Information is believed to be accurate as of the production date; however, it is subject to change. [Narrator] Your child has an earache at 2:00 AM? WebWe do not offer every plan available in your area. No fee schedules, basic unit, relative values or related listings are included in CPT. 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. 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. This site has its own log in. Visit the Teladoc Health website to connect with a provider at your convenience. Teladoc is not available to all members. 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. For language services, please call the number on your member ID card and request an operator. Call 1-800-MEDICARE (1-800-633-4227) or ${tty}: 1-877-486-2048, 7 days a week, 24 hours a day.If you need help in a language other than English or Spanish, say Agent to 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. 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. In addition, coverage may be mandated by applicable legal requirements of a State or the Federal government. Get started with Teladoc Health through the Aetna HealthSMapp. Medicare coverage for the whole you body, mind and spirit, Discover coverage that takes a total approach to health, See how we help you get the right resources and care, Take full advantage of everything your plan offers you. Each main plan type has more than one subtype. Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search. 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. You've probably heard of them but what does it really mean for you? Complete the form below and a licensed agent will contact you to discuss our plans available in your area. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. Were bringing you to our trusted partner to help process your payments. 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. Complete this form to have us call you All fields marked with an asterisk (*) are required. Medicare coverage for the whole you body, mind and spirit, Discover coverage that takes a total approach to health, See how we help you get the right resources and care, Take full advantage of everything your plan offers you. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. The American Medical Association (AMA) does not directly or indirectly practice medicine or dispense medical services. 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. All fields marked with an asterisk (*) are required. But you never need to pay for a new card. WebHMO and Medicare Advantage - 1-800-624-0756 (TTY: 711) Indemnity and PPO-based plans - 1-888-MD AETNA (1-888-632-3862) (TTY: 711) Voluntary plans - 1-888-772-9682 (TTY: To help us direct your question or comment to the correct area, please select a category below. I am a non-physician health care professional who wants to be available for selection as a primary care provider (PCP), and my state regulations allow me to serve as a PCP. In case of a conflict between your plan documents and this information, the plan documents will govern. Aetna handles premium payments through InstaMed, a trusted payment service. When billing, you must use the most appropriate code as of the effective date of the submission. 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. Our plan selection pages will be down for maintenance starting Friday, April 16, at 9 p.m. and returning by 1 p.m. Saturday, April 17. Aetna handles premium payments through Payer Express, a trusted payment service. In addition, a member may have an opportunity for an independent external review of coverage denials based on medical necessity or regarding the experimental and investigational status when the service or supply in question for which the member is financially responsible is $500 or greater. And Medicare will never call out of the blue to say youll lose Were bringing you to our trusted partner to help process your payments. 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.