Billing for COVID-19 Vaccines

A year ago billers were scrambling to learn how to bill for COVID-19 testing.  Now we are scrambling to learn how to bill for COVID-19 Vaccines!  CMS, the AMA, the WHO and the CDC have had to scramble as well.  First to come out with ICD 10 codes for COVID-19, such as Z11.52 for encounter for screening for COVID-19 and Z20.822 for contact with and suspected exposure to COVID-19.  And to come out with CPT codes for COVID-19 testing, and now to come out with CPT codes for the vaccines.

So let’s get right to it.  As with all vaccines there are two codes for each vaccine.  The first code is for the actual vaccine or the substance that is injected into the patient.  The second code is the administration code, which is to cover the cost of the supplies, and the manpower to administer the vaccine.  There is a separate allowance for each and it is important that both codes are billed so that the provider is reimbursed appropriately.  The vaccine charge is just to cover the cost of the actual vaccine that is being used.  The administration charge covers the providers’ materials and time.

They introduced separate codes for each manufacturer and a separate administration code for each dose.  With the Pfizer and Moderna vaccines there are two doses for each vaccine.  The Johnson & Johnson vaccine is only a one dose vaccine. 

Currently only the three vaccines are available in the US.  The Janssen, or J & J vaccine was on a pause for almost two weeks, but has been reinstated.  There is another vaccine being used in Europe by AstraZeneca but it has not been approved yet in the US.  The AstraZeneca vaccine is also a two shot vaccine.

The new CPT and HCPCS codes that have been introduced to cover the vaccine are as follows:

91300   –             Pfizer COVID-19 Vaccine  (the actual substance that is being injected)

0001A   –             administration for the first dose of the Pfizer COVID-19 vaccine

0002A  –              administration for the second dose of the Pfizer COVID-19 vaccine

91301   –             Moderna COVID-19 Vaccine  (the actual substance that is being injected)

0011A   –             administration for the first dose of the Moderna COVID-19 vaccine

0012A  –              administration for the second dose of the Moderna COVID-19 vaccine

91302   –             AstraZeneca COVID-19 Vaccine  (the actual substance that is being injected)

0021A   –             administration for the first dose of the AstraZeneca COVID-19 vaccine

0022A  –              administration for the second dose of the AstraZeneca COVID-19 vaccine

91303   –             Janssen (J&J) COVID-19 Vaccine  (the actual substance that is being injected)

0031A   –             administration for the first dose of the Janssen (J&J) COVID-19 vaccine

The ICD10 code that should be used for all vaccines is Z23 for encounter for immunization.  The US Government is providing the vaccine free of charge to all people living in the US so the charge for the actual vaccine is only $0.01.  The national payment allowance for the administration is currently $40.  The Medicare allowed amounts for the administration vary depending on the area of the country and whether it is the first or second dose of the vaccine.  It also depends on when the vaccine was administered. 

It really isn’t too complicated and is much like billing for other vaccinations.  Hopefully this article will help clear up any confusion!

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