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COVID-19 vaccine and Monoclonal Antibody Billing for Part B Providers

Guidelines for COVID-19 vaccines and monoclonal antibodies Billing

The patient can get the vaccines including of booster dose and or additional doses.

The patient administered the vaccine with no out of pocket cost for both vaccines and administration of the vaccines.

Vaccinate everyone, including the uninsured, regardless of coverage or network status.

When COVID-19 vaccine and monoclonal antibody doses are provided by the government without charge, only bill for the vaccine administration. Don't include the vaccine codes on the claim when the vaccines are free.

If the patient is enrolled in a Medicare Advantage (MA) plan, submit your COVID-19 vaccine and monoclonal antibody infusion claims to Original Medicare in 2020 and 2021. On or after January 1, 2022, claims for vaccine or mAb administrations for Medicare Advantage enrollees should be submitted to the Medicare Advantage plan. 

For services provided to Medicare Advantage enrollees on or after January 1, 2022, contact the Medicare Advantage for guidance on coverage and billing.

Code Description                                         Vaccine Name Effective date

91300* SARSCOV2 VAC 30MCG/0.3ML IM         Pfizer     12-11-2020

0001A ADM SARSCOV2 30MCG/0.3ML 1ST         Pfizer     12-11-2020

0002A ADM SARSCOV2 30MCG/0.3ML 2ND Pfizer     12-11-2020

0003A ADM SARSCOV2 30MCG/0.3ML 3RD         Pfizer     08-12-2021

0004A ADM SARSCOV2 30MCG/0.3ML BST         Pfizer     09/22/2021

91301* SARSCOV2 VAC 100MCG/0.5ML IM         Moderna    12/18/2020

0011A ADM SARSCOV2 100MCG/0.5ML1ST Moderna    12/18/2020

0012A ADM SARSCOV2 100MCG/0.5ML2ND Moderna    12/18/2020

0013A ADM SARSCOV2 100MCG/0.5ML3RD Moderna    08-12-2021

91303* SARSCOV2 VAC AD26 .5ML IM                 Janssen     02/27/2021

0031A ADM SARSCOV2 VAC AD26 .5ML         Janssen     02/27/2021

0034A ADM SARSCOV2 VAC AD26 .5ML B         Janssen     10/20/2021

91305* SARSCOV2 VAC 30 MCG TRS-SUCR         Pfizer     01-03-2022

0051A ADM SARSCV2 30MCG TRS-SUCR 1         Pfizer     01-03-2022

0052A ADM SARSCV2 30MCG TRS-SUCR 2         Pfizer     01-03-2022

0053A ADM SARSCV2 30MCG TRS-SUCR 3     Pfizer     01-03-2022

0054A ADM SARSCV2 30MCG TRS-SUCR B     Pfizer     01-03-2022

91306* SARSCOV2 VAC 50MCG/0.25ML IM         Moderna    10/20/2021

0064A ADM SARSCOV2 50MCG/0.25MLBST Moderna    10/20/2021

91307* SARSCOV2 VAC 10 MCG TRS-SUCR         Pfizer     10/29/2021

0071A ADM SARSCV2 10MCG TRS-SUCR 1         Pfizer     10/29/2021

0072A ADM SARSCV2 10MCG TRS-SUCR 2         Pfizer     10/29/2021

0073A ADM SARSCV2 10MCG TRS-SUCR 3         Pfizer     01-03-2022

M0201** COVID-19 vaccine home admin         N/A             06-08-2021

**Providers should not bill for the product if they received it for free.

**The services are covered only in places of service 04, 06, 09, 12, 13, 14, 16, 19, 22, 33, 54, 55, 56, and 60

Monoclonal antibodies and administration

Code Description                                 Effective date

Q0220* Tixagev and cilgav, 300mg         12-08-2021

Q0221* Tixagev and cilgav, 600mg         02/24/2022

M0220 Tixagev and cilgav inj                 12-08-2021

M0221 Tixagev and cilgav inj hm         12-08-2021

Q0222* Bebtelovimab 175 mg                 02-11-2022

M0222 Bebtelovimab injection         02-11-2022

M0223 Bebtelovimab injection home 02-11-2022

Q0239* bamlanivimab-xxxx                 11/10/2020 – 04/16/2021

M0239 bamlanivimab-xxxx infusion 11/10/2020 – 04/16/2021

Q0240* Casirivi and imdevi 600mg         07/30/2021

M0240 Casiri and imdev repeat         07/30/2021

M0241 Casiri and imdev repeat hm 07/30/2021

Q0243* casirivimab and imdevimab 11/21/2020

M0243 Casirivi and imdevi inj                 11/21/2020

Q0244* casirivi and imdevi 1200 mg 06-03-2021

M0244 Casirivi and imdevi inj hm         05-06-2021

Q0245* bamlanivimab and etesevima 02-09-2021

M0245 bamlan and etesev infusion 02-09-2021

M0246 bamlan and etesev infus home 05-06-2021

Q0247** sotrovimab                         05/26/2021

M0247 sotrovimab infusion                 05/26/2021

M0248 sotrovimab inf, home admin 05/26/2021

Q0249** Tocilizumab for COVID-19 06/24/2021

M0249 Adm Tocilizu COVID-19 1st         06/24/2021

M0250 Adm Tocilizu COVID-19 2nd 06/24/2021

Note:

  • *Providers should not bill for the product if they received it for free.
  • **The government won’t provide this drug for free.

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