Billing for the COVID-19 Vaccine

As the COVID-19 vaccines are rolled out on an emergency basis, billers and coders are scrambling to find and use the right codes for maximum reimbursement. There is much information out there that will be consolidated into this article to help with this dilemma. In addition, a website has been established by the American Medical Association (AMA) to assist with further question. (https://www.ama-assn. org/practice-management/cpt/covid-19-cpt-vaccineand-immunization-codes)

As the AMA CPT has approved and the Emergency Use Authorization (EUA) has been issued for the Pfizer vaccine the following codes can be used for COVID-19 vaccine administration:

• 90460 – The is used for the “Immunization administration through 18 years age via any route of administration. . . first or only component of each vaccine.”

• +90461 – “each additional vaccine . . administered (list code in addition to primary code)
“Do not report 90460, 90451 in conjunction with 91300, 91301 or 91302 unless both a severe acute respiratory syndrome . . and at least one vaccine product from 90476 – 90479 are administered at the same time”(Association, 2020, p. 2)

• 0011A – “Immunization administration by intramuscular injection of severe acute respiratory syndrome . . . vaccine, mRNA-LNP, spike protein, preservative free, 100mcg/0.5mL dosage; first dose.

• 0012A – “second dose (Report 0011A, 0012A for the administration of 91301)” (Covid-19 Cpt Vaccine and Immunization Codes | American Medical Association, n.d., p. 2)

• 0021A – “Immunization administration by intramuscular injection of . . . coronavirus 20. . . vaccine, DNA, spike protein . . viral particles/0.5 mL dosage, first dose.” (Moderna)

• 0022A – “second dose, (Report 0021A, 0022A for the administration of vaccine 91302.

• 91300 – “Severe acute respiratory syndrome . . . vaccine, mRNA-LNP, spike protein preservative free, 30 mcg/0.3mL dosage, diluent reconstituted, for intramuscular use.” (Pfizer)

• 91301 – “Severe acute respiratory syndrome . . . vaccine, mRNA-LNP, spike protein preservative free 100 mcg/0.5 mL dosage, for intramuscular use.” (Moderna) (Report 91301 with administration codes 0011A, 0012A)

• 91302 – “Severe acute respiratory syndrome . . . vaccine, DNA, spike protein . . . preservative free, 5×1010 viral particulates/0.5 mL dosage, for intramuscular use.” (Report 91302 with administration codes 0021A, 0022A) (Association, 2020, p. 2)

Because of the new coding, Appendix Q has been added to the CPT code set, listing the vaccine codes along with their associated vaccine administration codes, the vaccine manufacturer and the National Drug Code (NDC) and dosing interval. All of the above listed codes are present in Appendix Q. There is more helpful information at the website https:// www.ama-assn.org/practice-management/cpt/ covid-19-cpt-coding-and-guidance.

As far as administration codes are concerned, at this time, Centers for Medicare and Medicaid (CMS) are allowing Medicare providers to charge $16.94 for the first dose and $28.39 for the second. Single dose vaccines will be reimbursed at $28.39. If a clearly definable Evaluation and Management (E/M) component is part of the visit, the appropriate E/M code can be charged additionally. Medicaid reimbursements will vary by state.

Commercial payment will vary however, the federal government has stated that the Medicare reimbursements should be considered fair. For uninsured patients, providers can apply for reimbursement through the Provider Relief Fund, where they will generally be reimbursed subject to funding availability.

Although the originally shipped vaccines have been sent free of charge, providers can still charge for the administration of these injections. Listed below are some of the ICD-10 codes that can be used in conjunction with the CPT codes discussed earlier:

• XW013S6 – Introduction of COVID-19 vaccine dose 1 into subcutaneous tissue, percutaneous approach, new technology group 6.

• XW013T6 – Introduction of COVID-19 vaccine dose 2 into subcutaneous tissue, percutaneous approach, new technology group 6.

• XW013U6 – Introduction of COVID-19 vaccine into subcutaneous tissue, percutaneous approach, new technology group 6.

• XW023S6 – Introduction of COVID-19 vaccine dose 1 into muscle, percutaneous approach, new technology group 6.

• XW023T6 – Introduction of COVID-19 vaccine dose 2 into muscle, percutaneous approach, new technology group 6

• XW023U6 – Introduction of COVID-19 vaccine tissue, percutaneous approach, new technology group 6.

Roster billing can be done as well, if the provider sees and administers five or more vaccines on the same date of service. Otherwise, the claims can be submitted on a CMS-1500.

References

Association, A. M. (2020). Cpt assistang: Covid-19 december update [PDF]. Retrieved December 21, 2020, from https://www.ama-assn.org/system/files/2020-12/cpt-assistant-guide-covid-vaccine-coding-special-edition-2020.pdf

Covid-19 cpt vaccine and immunization codes | american medical association. (n.d.). American Medical Association. Retrieved December 21, 2020, from https://www.ama-assn.org/practice-management/cpt/covid-19-cpt-vaccine-and-immunization-codes

Cpt-assistant-guide-covid-vaccine-coding-2020 [PDF]. (2020). Retrieved December 21, 2020, from https://www.ama-assn.org/system/files/2020-11/cpt-assistant-guide-covid-vaccine-coding-2020.pdf

Medicare finalizes covid-19 vaccine payment amounts – aapc knowledge center. (2020, November 11). AAPC Knowledge Center. Retrieved December 21, 2020, from https://www.aapc.com/blog/52244-medicare-finalizes-covid-19-vaccine-payment-amounts/

RevCycleIntelligence. (2020, December 16). Key considerations for covid-19 vaccine billing and coding. Retrieved December 21, 2020, from https://revcycleintelligence.com/news/key-considerations-for-covid-19-vaccine-billing-and-coding?eid=CXTEL000000602991&elqCampaignId=17223