Medicare: COVID-19 Vaccination Billing Guidelines

Date: 12/15/20

Claims for administering the COVID-19 vaccine must be submitted to your CMS Medicare Administrative Contractor (MAC).

Allwell from Louisiana Healthcare Connections is closely following advancements in the prevention and treatment of COVID-19, including vaccinations. As a healthcare provider, you will play an integral role as COVID-19 vaccines become available. We want to update you on important new information about vaccine coverage.

To prepare for vaccine administration, the Centers for Medicare and Medicaid (CMS) have published billing guidelines for Medicare providers.  Similar to other COVID-19 services, the vaccines will be offered at no cost to your patients. However, please be aware the following billing specifics:

• For Calendar Years (CYs) 2020 and 2021, Medicare payment for the COVID-19 vaccine and its administration for Medicare Advantage plan members will be made through the original fee-for-service Medicare program.
• Allwell from Louisiana Healthcare Connections will not be able to process these claims.
• Therefore, providers must submit claims for administering the COVID-19 vaccine to their CMS Medicare Administrative Contractor (MAC) using product-specific codes for each vaccine approved.

The American Medical Association (AMA) has published updates to the Current Procedural Terminology (CPT®) code set that includes new vaccine-specific codes to report immunizations for the novel coronavirus (SARS-CoV-2). The code set will continue to be updated as additional vaccines receive emergency use authorization (EUA) approval by the U.S. Food & Drug Administration (FDA).

The following codes have been published as of November 10, 2020. However, they will not be billable until the specific vaccine receives official EUA approval.

Code	CPT Short Descriptor	Labeler Name	Vaccine/Procedure Name
91300	SARSCOV2 VAC 30MCG/0.3ML IM	Pfizer	Pfizer-Biotech Covid-19 Vaccine
0001A	ADM SARSCOV2 VAC 30MCG/0.3ML 1ST	Pfizer	Pfizer-Biotech Covid-19 Vaccine Administration – First Dose
0002A	ADM SARSCOV2 VAC 30MCG/0.3ML 2ND	Pfizer	Pfizer-Biotech Covid-19 Vaccine Administration – Second Dose
91301	SARSCOV2 VAC 100MCG/0.5ML IM	Moderna	Moderna Covid-19 Vaccine
0011A	ADM SARSCOV2 VAC 100MCG/0.5ML 1ST	Moderna	Moderna Covid-19 Vaccine Administration – First Dose
0012A	ADM SARSCOV2 VAC 100MCG/0.5ML 2ND	Moderna	Moderna Covid-19 Vaccine Administration – Second Dose

Additionally, CMS has also published a set of toolkits to help providers prepare to swiftly administer the vaccine once it is available. If you have any further questions about this upcoming vaccine or the COVID-19 services Allwell covers, please contact Provider Services at 1-866-595-8133.