Coding & Reimbursement for COVID-19 Vaccinations

Blog, COVID January 6, 2021 at 9:13 am

At last, the US is starting to vaccinate against COVID-19. For practices that are, or plan on administering the vaccinations, there are specific codes that will need to be used to receive reimbursement. Equally important is that there are a different administration codes for each manufacturer as well as for the first and second doses. Let’s take a look at how coding and reimbursement will work for coronavirus vaccines.

AMA Issues New CPT Codes for COVID-19 Vaccinations

In November the AMA approved and published two new CPT vaccine codes and their associated administration codes for the Pfizer and Moderna vaccines. These codes became effective when the FDA granted emergency use authorization.

The AMA assigned Category I code 91300 to the Pfizer vaccine and code 91301 to Moderna. To document the administration of the covid-19 vaccinations, AMA has also created codes 0001A, 0002A, 0011A, and 0012A. Code 0001A and 0011A describes the administration of the first dose of the Pfizer and Moderna vaccine respectively, while 0002A and 0012A describes the second dose of the vaccine.

In December, the AMA also released a new code and associated codes for the AstraZenenca covid-19 vaccination for COVID-19. These codes are subject to FDA approval or an emergency use authorization.

Payment Allowances and Effective Dates for the COVID-19 Vaccination and Administration

CMS has stated that it will reimburse providers for the COVID-19 vaccination and their administration costs, but some restrictions apply.

• CMS will reimburse only for those covid-19 vaccinations that are approved by the FDA or have emergency use authorization.
• CMS will reimburse under Medicare Part B instead of Part D to provide the broadest coverage.
• Medicare will provide 95% of the wholesale price of the covid-19 vaccination. However, providers cannot bill for vaccines they have received for free.
• Since CMS anticipates that providers, initially, will not incur a cost for the product they have set the payment allowances at $0.10 for the vaccines and will update the payment allowance at a later date when practices incur costs.
• Administration of the covid-19 vaccine are set at $16.94 for the first does and $28.39 for the second. These rates will be geographically adjusted as outlined in the Medicare Physician Fees Schedule.

Payment Allowances and Effective Dates for COVID-19 Monoclonal Antibodies and Administration

CMS also stated that it will reimburse providers for COVID-19 monoclonal antibodies and their administration costs, but similar to the covid-19 vaccinations, some restrictions apply.

• CMS will reimburse only for those COVID antibodies that are approved by the FDA or have emergency use authorization.
• Medicare will provide 95% of the wholesale price. However, providers cannot bill for antibodies they have received for free.
• Payment allowances have initially been set at $0.10 for the injections and will be updated at a later date when practices begin to incur costs.
• Medicare will pay a rate of $309.60 for many providers. This payment rate is based on one hour of infusion and post-administration monitoring in the hospital outpatient setting.
• These rates will also be geographically adjusted for many providers according to the Medicare Physician Fee Schedule.

Are you using CPT 99072?

This relatively new CPT code is different to the 99070 normally used to report additional supplies. It can be used instead of 99070 to cover the additional supplies, materials, and clinical staff time required to support safe in-person patient interactions during the COVID-19 Public Health Emergency (PHE). Check with your payers to make sure they are covering the code prior to using it, and make sure you check the documentation guidelines. It is also easy to set up templates to quickly document the time you spend, and extra supplies used.