The COVID-19 pandemic has led to a tumultuous year for people around the world. Thankfully, effective vaccines have recently been approved, bringing much-needed hope that this health crisis will soon end.
Although the end of the pandemic may be near, the process of vaccinating millions of people has just begun for healthcare organizations. The U.S government has already started distributing the vaccine across the country, with healthcare workers being the first to receive access.
More doses and approvals are likely on the way, although some are fearful of the daunting task of vaccinating the entire population.
“A mass vaccination effort with the first available COVID-19 vaccines presents enormous logistical challenges,” said AMA (American Medical Association) President Susan R. Bailey, MD. “The ability to correlate each COVID-19 vaccine with its own unique CPT code provides analytical and tracking advantages that ensure optimal vaccine distribution and administration, especially for patients who will need to complete the two-dose immunization schedule.”
Coding for U.S Government Issued COVID-19 Vaccines
Although the vaccine will be distributed for free, the U.S government does need accurate medical billing details from providers to ensure a successful distribution effort across the country.
Since the vaccine is being given away by the U.S government, healthcare providers will only be expected to submit claims for vaccine administration. There won’t be a need to submit CPT codes for free vaccines that are received by healthcare providers. Administration efforts for these government-issued vaccines, however, will be reimbursed.
The American Medical Association (AMA) has updated its Current Procedural Terminology (CPT) code set to include new vaccine-specific codes for COVID-19 (also known as SARS-CoV-2).
CPT codes have been developed for the Pfizer-BioNTech and Moderna vaccines, along with a newer code for the AstraZeneca vaccine being developed at the University of Oxford. There are unique codes for each of the three different vaccines along with administration codes to go along with them.
Here are the new Category 1 CPT codes and descriptors for the different vaccines:
Pfizer and Moderna Vaccines:
- 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 dosages, 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 dosages, for intramuscular use. (Moderna)
- 91302: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, chimpanzee adenovirus Oxford 1 (ChAdOx1) vector, preservative-free, 5×1010 viral particles/0.5mL dosage, for intramuscular use.
For administration purposes, the following codes have also been developed:
- Pfizer (first dose): 0001A
- Pfizer (second dose): 0002A
- Moderna (first dose): 0011A
- Moderna (second dose): 0012A
- AstraZeneca (first dose): 0021A
- AstraZeneca (second dose): 0022A
Reimbursing COVID-19 Vaccines for Medicare Patients
Healthcare providers will be able to bill for both single claims for COVID-19 shot administration or for a roster bill for multiple patients at one time. There will be no need to include the vaccine codes on claims when vaccines are free.
If healthcare providers are participants in a Medicare Advantage Plan, they can submit COVID-19 claims to Original Medicare for all patients enrolled in Medicare Advantage in 2020 and 2021.
Providers that are contracted by Medicare Advantage can submit claims for administering the COVID-19 vaccine to Original Medicare through their Medicare Administrative Contractor (MAC).
For institutional claims that utilize roster billing, providers will need to administer shots to a minimum of 5 patients on the same date, unless the institution is an inpatient hospital. Providers can also submit individual claims.
Here are the valid types of bills for roster billing:
- 12X, Hospital Inpatient**
- 13X, Hospital Outpatient**
- 22X, Skilled Nursing Facility (SNF) covered Part A stay (paid under Part B) & Inpatient Part B
- 23X, SNF Outpatient
- 34X, Home Health (Part B Only)
- 72X, Independent and Hospital-based Renal Dialysis Facility
- 75X, Comprehensive Outpatient Rehabilitation Facility
- 81X, Hospice (Non-hospital)
- 82X, Hospice (Hospital)
- 85X, Critical Access Hospital
** For hospitalized patients, Medicare pays for the COVID-19 shots separately from the Diagnosis-Related Group rate and disallows billing them on 11X.
To learn more please click here to visit the CMS Website.
ICD-10 Codes for COVID-19
Due to the ongoing COVID-19 public health crisis, the Centers for Disease Control and Prevention’s National Center for Health Statistics (CDC/NCHS) will be implementing more codes into the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM).
Reporting will include:
- Encounter for screening for COVID-19 (Z11.52)
- Contact with and (suspected) exposure to COVID-19 (Z20.822)
- Personal history of COVID-19 (Z86.16)
- Multisystem inflammatory syndrome (MIS) (M35.81)
- Other specified systemic involvement of connective tissue (M35.89)
- Pneumonia due to coronavirus disease 2019 (J12.82)
These codes will go into effect on January 1, 2021 to help identify conditions that have resulted from COVID-19. For more information on ICD-10-CM interim coding guidance, please click here.
Originally, the World Health Organization (WHO) created ICD-10-CM codes for COVID-19, which were adopted by the CDC in March 2020 and made effective on April 1, 2020. More than twenty additional codes have been created since that date, of which six are for vaccine administration.