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PROVIDER BILLING GUIDANCE FOR COVID-19 TESTING

We are closely monitoring and following all guidance from the Centers for Medicare and Medicaid as it is released to ensure we can quickly address and support the prevention, screening, and treatment of COVID-19. The following guidance can be used to bill for services related to COVID-19 vaccinations, testing, screening and treatment services. This guidance is in response to the current COVID-19 pandemic and may be retired at a future date. For additional information and guidance on COVID-19 billing and coding, please visit the resource centers of the Centers for Medicare and Medicaid (CMS) and the American Medical Association (AMA).  

 

COVID-19 Vaccines 

  • All member cost share (copayment, coinsurance and/or deductible amounts) will be waived for claims billed with the new COVID-19 vaccine codes.
  • In addition to cost share, authorization requirements will be waived for any claim that is received with these specified codes. This includes non-participating providers.
  • Per CMS guidance, all Medicare claims for the COVID-19 vaccine and its administration must be billed directly to Original Medicare fee-for-service (FFS). 
  • All Medicare claims related to the COVID-19 vaccine codes will be denied, with direction to submit directly to Medicare FFS for payment.
  • The following codes have been published as of February 22, 2021. NOTE: Vaccines will not be billable until the specific vaccine receives official EUA approval. Currently approved vaccines are denoted by their effective date below.  
Code CPT Short Descriptor Labeler Name Vaccine/Procedure Name Effective Date
91300

SARSCOV2 VAC

30MCG/0.3ML IM

Pfizer Pfizer-BioNTech Covid-19 Vaccine 12/11/2020
0001A

ADM SARSCOV2 VAC

30MCG/0.3ML 1ST

Pfizer Pfizer-BioNTech Covid-19 Vaccine 12/11/2020
0002A

ADM SARSCOV2 VAC

30MCG/0.3ML 2ND Pfizer

Pfizer Pfizer-BioNTech Covid-19 Vaccine 12/11/2020
91301

SARSCOV2 VAC

100MCG/0.5ML IM

Moderna  Moderna Covid-19 Vaccine 12/18/2020
0011A

ADM SARSCOV2 VAC

100MCG/0.5ML 1ST

Moderna  Moderna Covid-19 Vaccine 12/18/2020
0012A

ADM SARSCOV2 VAC

100MCG/0.5ML 2ND

Moderna  Moderna Covid-19 Vaccine 12/18/2020
91303

SARSCOV2 VAC 

AD26 .5ML IM

Janssen  Janssen Covid-19 Vaccine 2/22/2021
0031A

ADM SARSCOV2 VAC 

AD26 .5ML

Janssen  Janssen Covid-19 Vaccine Administration 2/22/2021

Last updated: 12.10.2020Additionally, 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 from Arkansas Health & Wellness covers, please contact Provider Services at 1-800-294-3557.