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
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)
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
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:
- 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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