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Three COVID-19 vaccines, manufactured by Pfizer, Moderna and Janssen Biotech (Johnson & Johnson), have received Emergency Use Authorization from the U.S. Food and Drug Administration.
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Getting Paid for 7 New CPT Codes for COVID-19 vaccine Administration
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Three COVID-19 vaccines, manufactured by Pfizer, Moderna and Janssen Biotech (Johnson & Johnson), have received Emergency Use Authorization from the U.S. Food and Drug Administration. The vaccine itself will be paid for through funding authorized by the Coronavirus Aid, Relief, and Economic Security (CARES) Act for everyone. Providers should not bill for the cost of the vaccine for any free, government-provided vaccine products.
CPT CODE FOR CORONAVIRUS VACCINE
91300
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative-free, 30 mcg/0.3mL dosage, diluent reconstituted, for intramuscular use. (Pfizer)
91301
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative-free, 100 mcg/0.5mL dosage, for intramuscular use. (Moderna)
91303
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, adenovirus type 26 (Ad26) vector, preservative free, 5×1010 viral particles/0.5mL dosage, for intramuscular Use (J&J-Janssen)
COVID-19 VACCINE ADMINISTRATION CODES
The coronavirus vaccine administration codes are specific to the coronavirus vaccine and the dosage. Vaccine administration codes report the work of administering the vaccine, counseling the patient or caregiver, and documenting the medical record.
The CPT Editorial Panel has worked with the Centers for Medicare & Medicaid Services to create new vaccine administration codes that are both distinct to each COVID-19 vaccine and the specific dose in the required schedule. Providers can use these codes to bill for administering authorized vaccines:
- 0001A – Pfizer dose 1
- 0002A – Pfizer dose 2
- 0011A – Moderna dose 1
- 0012A – Moderna dose 2
- 0021A – AstraZeneca dose 1 (pending EUA approval)
- 0022B – AstraZeneca dose 2 (pending EUA approval)
- 0031A – Janssen (only 1 dose required)
ICD-10 Codes for vaccine administration
Z23 Encounter for immunization
For commercial members: Providers should bill for administration of the vaccine using the appropriate codes.
For Medicare Advantage members: Submit claims for administering COVID-19 vaccines to Original Medicare. Medicare Advantage providers can refer to for more information on submitting claims.
Medicare Payment Rates: On March 15, 2021, CMS is updating the Medicare payment rates for COVID-19 vaccine administration. Effective for services furnished on or after March 15, 2021, the new Medicare payment rate for administering a COVID-19 vaccine will be approximately $40 to administer each dose of a COVID-19 vaccine. This rate reflects updated information about the costs involved in administering the COVID-19 vaccine for different types of providers and suppliers, and the additional resources necessary to ensure the vaccine is administered safely and appropriately. The rate will be geographically adjusted based on where the service is furnished.
Providers will be prohibited from charging consumers for administration of the vaccine. To ensure broad and consistent coverage, the toolkits have specific information for several programs, including:
- Medicare: Beneficiaries with Medicare pay nothing for COVID-19 vaccines and their copayment/coinsurance and deductible are waived.
- Medicare Advantage (MA): For calendar years 2020 and 2021, Medicare will pay directly for the COVID-19 vaccine and its administration for beneficiaries enrolled in MA plans. MA plans would not be responsible for reimbursing providers to administer the vaccine during this time. Medicare Advantage beneficiaries also pay nothing for COVID-19 vaccines and their copayment/coinsurance and deductible are waived.
- Medicaid: State Medicaid agencies must provide vaccine administration with no cost sharing for most beneficiaries during the public health emergency.
- Private Plans: CMS, along with the Departments of Labor and the Treasury, is requiring that most private health plans and issuers cover a recommended COVID-19 vaccine and its administration, both in-network and out-of-network, with no cost sharing. The rule also provides that out-of-network rates cannot be unreasonably low, and references CMS’s reimbursement rates as a potential guideline for insurance companies.
- Medicare: Beneficiaries with Medicare pay nothing for COVID-19 vaccines and their copayment/coinsurance and deductible are waived.
- Uninsured: For individuals who are uninsured, providers will be able to be reimbursed for administering the COVID-19 vaccine to individuals without insurance through the Provider Relief Fund, administered by the Health Resources and Services Administration (HRSA).
Resources:
- Download the January 2021 special edition of the CPT Assistant guide (PDF, includes information on SARS-CoV-2 Vaccines on codes 91303, 0031A)
- CPT ® Category I New SARS-CoV-2 Vaccine Codes Medium Descriptors
- Medicare Billing for COVID-19 Vaccine Shot Administration
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