Medical Coding Rights

The Pneumococcal Vaccine CPT codes will be payable by Medicare. The new codes will be in the 2021 Medicare Physician Fee Schedule Database file update and the annual HCPCS update.  90677-  Pneumococcal conjugate vaccine, 20 valent (PCV20), for intramuscular use. Which is effective for Dates of Service (DOS) on or after July 1, 2021 90671 - Pneumococcal conjugate vaccine, 15 valent (PCV15), for intramuscular use Which is effective for DOS on or after July 16, 2021  The CPT 90677 does not apply for Coinsurance and deductible. A Medicare Administrative Contractor (MAC) will pay institutional providers for these codes based on the Type of Bill (TOB) used. The two payment methods are,        1. The Medicare Administrative Contractor (MAC) will pay these institutional providers using reasonable cost if you use the following, Hospitals (TOBs 12X and 13X) Skilled Nursing Facilities (TOBs 22X and 23X) Home Health Agencies (TOB 34X) Hospital-based Renal Dialysis Facilities (RDFS) (TOB 72X) Crit

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 Medi

 HCPCS/CPT Codes 90630 Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, for intradermal use 90653 Influenza vaccine, inactivated (IIV), subunit, adjuvanted, for intramuscular use 90654 Influenza virus vaccine, trivalent (IIV3), split virus, preservative-free, for intradermal use 90655 Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.25 mL dosage, for intramuscular use 90656 Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.5 mL dosage, for intramuscular use 90657 Influenza virus vaccine, trivalent (IIV3), split virus, 0.25 mL dosage, for intramuscular use 90658 Influenza virus vaccine, trivalent (IIV3), split virus, 0.5 mL dosage, for intramuscular use 90660 Influenza virus vaccine, trivalent, live (LAIV3), for intranasal use 90661 Influenza virus vaccine, trivalent (ccIIV3), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use 90662 Influenza virus

HCPCS/CPT Codes 90670 – Pneumococcal conjugate vaccine, 13 valent (PCV13) , for intramuscular use 90732 – Pneumococcal polysaccharide vaccine, 23-valent (PPSV23) , adult or immunosuppressed patient dosage, when administered to individuals 2 years or older, for subcutaneous or intramuscular use G0009 – Pneumococcal Administration ICD-10 Codes The specified below ICD codes are covered for CPT G0102 and G0103 but may not be limited and some private payers having specific guidelines. Z23         Encounter for immunization Z71.84 Encounter for health counseling related to travel Who Is Covered All Medicare beneficiaries Fee Value and MUE Edits         CPT         Dosage   Fee    MUE        90670 0.5 ml $241.383 1        90732 0.5 ml $125.918 1 Frequency An initial pneumococcal vaccine to Medicare beneficiaries who never received the vaccine under Medicare Part B A different, second pneumococcal vaccine 1 year after the first vaccine was administered Medicare Beneficiar

HCPCS/CPT Codes 90739 – Hepatitis B vaccine, adult dosage (2 dose schedule), for intramuscular use 90740 – Hepatitis B vaccine, dialysis or immunosuppressed patient dosage (3 dose schedule), for intramuscular use 90743 – Hepatitis B vaccine, adolescent (2 dose schedule), for intramuscular use 90744 – Hepatitis B vaccine, pediatric/adolescent dosage (3 dose schedule), for intramuscular use 90746 – Hepatitis B vaccine, adult dosage (3 dose schedule), for intramuscular use 90747 – Hepatitis B vaccine, dialysis or immunosuppressed patient dosage (4 dose schedule), for intramuscular use G0010 – Administration of Hepatitis B vaccine Covered ICD-10 Codes for CPT 90739, 90740, 90743, 90744, 90746, 90747 The specified below ICD codes are covered for CPT G0472 and may not be limited and some private payers have own specific guidelines, Z23          Encounter for immunization R74.01 Elevation of levels of liver transaminase levels Z71.84 Encounter for health counseling related to travel Cover

Third Dose of Moderna COVID-19 vaccine CPT code has been released, 0013A - Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5 mL dosage; third dose Other  administration codes are,  0011A -   Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5mL dosage; first dose 0012A -  Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5mL dosage; second dose Vaccine CPT Code 91301-  Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, pr

Coverage without cost-sharing available for eligible people with Medicare, Medicaid, CHIP, and Most Commercial Health Insurance Coverage Following the FDA’s recent action that authorized a booster dose of the Pfizer COVID-19 vaccine for certain high-risk populations and a recommendation from the CDC, CMS will continue to provide coverage for this critical protection from the virus, including booster doses, without cost sharing. Beneficiaries with Medicare pay nothing for COVID-19 vaccines or their administration, and there is no applicable copayment, coinsurance, or deductible.  In addition, thanks to the American Rescue Plan Act of 2021, nearly all Medicaid and CHIP beneficiaries must receive coverage of COVID-19 vaccines and their administration, without cost-sharing. COVID-19 vaccines and their administration, including boosters, will also be covered without cost-sharing for eligible consumers of most issuers of health insurance in the commercial market.  CMS continues to explore wa

 Immunization Administration  0001A - Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3 mL dosage, diluent reconstituted; first dose. 0002A - Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3 mL dosage, diluent reconstituted; second dose. 0003A - Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3 mL dosage, diluent reconstituted; third dose. 0004A - Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19])

The overall will protect patients of the 50,000 providers and over 17 million health care workers in Medicare and Medicaid certified facilities for COVID-19 Vaccines. The Centers for Medicare & Medicaid Services (CMS), in collaboration with the Centers for Disease Control and Prevention (CDC), announced that emergency regulations requiring vaccinations for nursing home workers will be expanded to include, Hospitals,  Dialysis facilities,  Ambulatory surgical settings,  Home health agencies. Nursing homes with an overall staff vaccination rate of 75% or lower experience higher rates of preventable COVID infection.  In CMS’s review of available data, the agency is seeing lower staff vaccination rates among hospital and End Stage Renal Disease (ESRD) facilities.  To combat this issue, CMS is using its authority to establish vaccine requirements for all providers and suppliers that participate in the Medicare and Medicaid programs.  Vaccinations have proven to reduce the risk of severe

PROVIDER RECEIVE THE INCREASED PAYMENTS UPTO 5 TIMES As part of the Biden-Harris Administration’s ongoing commitment to increasing access to vaccinations and improving health equity, CMS is expanding opportunities for people to receive COVID-19 vaccinations in their homes.  To ensure Medicare beneficiaries who have difficulty leaving their homes or are otherwise hard-to-reach can receive the vaccination, health care providers can now receive additional payments for administering vaccines to multiple residents in one home setting or communal setting of a home.   This announcement aims to further boost the administration of COVID-19 vaccination – including second and third doses – in smaller group homes, assisted living facilities, and other group living situations. The allowing vaccine providers to receive the increased payment up to 5 times when fewer than 10 Medicare beneficiaries get the vaccine on the same day in the same home or communal setting. 

COVID-19 Vaccine Additional Dose - Payment Medicare stands ready to pay for administering an additional dose of COVID-19 vaccine consistent with the FDA emergency use authorization (EUA).  They will pay the same amount to administer this additional dose as we did for other doses of the COVID-19 vaccine ( approximately $40 each) .  The U.S. Food and Drug Administration amended the emergency use authorizations (EUAs) for both the Pfizer-BioNTech COVID-19 Vaccine and the Moderna COVID-19 Vaccine to allow for the use of an additional dose in certain immunocompromised individuals, specifically, solid organ transplant recipients or those who are diagnosed with conditions that are considered to have an equivalent level of immunocompromise. Additional New CPT codes - COVID-19 Vaccine - Effective from 08/12/2021 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 c

There are four different types of administration of vaccine CPT codes found. Pediatrics patients up to 18 years of age - CPT 90460 & 90461. Adult age patients - CPT 90471 & 90472. For Intranasal or oral route - CPT 90473 & 90474 For COVID-19 vaccines - CPT 001A, 0002A, 0011A, 0012A, 0021A, 0022A, 0031A, 0041A, 0042A If the provider and or other qualified healthcare professional administers more than one vaccine, use the appropriate add-on codes. 90460 - Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first or only component of each vaccine or toxoid administered +90461 - Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; each additional vaccine or toxoid component administered (List separately in addition to code for primary procedure) 90471 - Immunization

The CPT Editorial Panel has released early an additional five new codes in the Medicine/Vaccine, Toxoids section of the AMA’s CPT Codes.  The following codes are effective from July 1, 2021, but won’t be published until CPT 2022, 90626 Tick-borne encephalitis virus vaccine, inactivated; 0.25 mL dosage, for intramuscular use 90627 Tick-borne encephalitis virus vaccine, inactivated; 0.5 mL dosage, for intramuscular use 90671 Pneumococcal conjugate vaccine, 15 valent (PCV15), for intramuscular use 90677 Pneumococcal conjugate vaccine, 20 valent (PCV20), for intramuscular use 90758 Zaire ebolavirus vaccine, live, for intramuscular use These codes will be listed out of sequence. Medicare coverage will be determined by the Centers for Medicare & Medicaid Services in future rulemaking.