The urgency for a safe, effective COVID-19 treatment has inspired scientists around the world and in the U.S. to approach vaccine development in novel ways that could soon yield the first major COVID-19 vaccine for the public. With this news comes an exhausting amount of other vaccine-related information such as various clinical trials, administrative protocols, vaccine recommendations and coding for the eventual COVID-19 vaccines.
Because of the rapidly evolving nature the current pandemic and the vaccination options that healthcare providers may have to address, we wanted to provide you with some of the specific, dependable references available as you are making decisions about how you will use, dispense, administer and recommend the vaccine in your practice.
Note: The FDA issued the first Emergency Use Authorization for a COVID-19 vaccine on December 11, 2020.
Vaccine-Specific CPT1 codes have been created for reporting of immunizations for the novel coronavirus.
- 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.
- 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.
- 0001A – 1st dose
- 0002A – 2nd dose
- Appendix Q will be added to the CPT book to accommodate the new vaccine administration coding structure and will include each product’s dosing information and manufacturer [Link]
- CPT® Category I New SARS-CoV-2 Vaccine Codes Long Descriptors [Link]
- CPT® Assistant [Link]
2. Billing and Reimbursement
- The vaccine will be added to the list of Medicare preventative services [Link]
- Full coverage of the vaccine for adults (Medicare) with no patient cost share2
- The administration rates will be:
- Single dose vaccines: $28.39 per dose
- Multiple doses vaccines: $16.94 for initial dose(s) and $28.39 for the final dose
If you are a Medicare Advantage contracted provider, submit claims for administering COVID-19 vaccines to original Medicare through your Medicare contractor, not the patient’s Medicare Advantage plan.
- LA and AR Medicare contractor, Novitas Solutions [Link]
- Billing for COVID-19 Vaccine Administration [Link]
- Payment Allowances and Effective Dates for COVID-19 Vaccines and their Administration [Link]
Commercial Health Plans
Check with the plan. Under the CARES (Coronovirus Aid, Relief and Economic Security Act and FFCRA (the Family First Coronavirus Response Act) vaccines should be covered:
- Without cost sharing (including the administration)2
- Regardless of provider “network” status2
- States have an incentive to cover the immunization and administration without cost share
- The development of a pediatric dose will likely follow the adult vaccine
- The vaccine should be offered for all children through age 20 who are eligible for EPSDT
3. Provider Enrollment
COVID-19 Enrollment website – Medicare [Link]
- Medicare providers already credentialed to give immunizations should not need any further credentialing.
- Some Medicare-enrolled providers must also separately enroll as a mass immunizer to administer and bill for COVID-19 vaccines when they’re available.
- Providers can enroll over the phone with their MAC.
- The Medicare and Medicaid programs will coordinate and share information so mass immunizers may not need to duplicate applications.
- Currently, LA Medicaid Provider Relations points to this bulletin [Link] as a reference to their planned enrollment protocol. See State Specific Vaccine Plans below.
4. Other Resources and Links
- CDC Vaccines [Link]
- FDA COVID-19 Vaccine Information [Link]
- FDA COVID-19 FAQ [Link]
- State Specific Vaccine Plans
- CMS Fourth COVID-19 Interim Final Rule – Fact Sheet [Link]
- CMS COVID-19 Toolkits [Link]
- CMS Toolkit on COVID-19 Vaccine: Health Insurance Issuers and Medicare Advantage Plans [Link]
- CMS Coverage and Reimbursement of COVID-19 Vaccines, Vaccine Administration and Cost Sharing under Medicaid, the Children’s Health Insurance Program, and Basic Health Program [Link]
- CDC: 10 Things Healthcare Professionals need to about COVID-19 Vaccination Plan [Link]
For more resources on COVID-19 vaccinations or general COVID-19 information, visit lammico.com/covid-19 or contact our Risk Management and Patient Safety Department at 504.841.5211.
For questions regarding third party payment, coverage and billing of the vaccines, tests and telehealth, please contact LAMMICO Practice Management Specialist, Natalie Cohen, MBA, MHA, at 504.841.2727 or firstname.lastname@example.org.
1. CPT® is a registered trademark of the American Medical Association
2. During the public health emergency