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Showing posts with label Vaccines. Show all posts
Showing posts with label Vaccines. Show all posts

Pneumococcal Vaccine Claims Processing Updates April 2022

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)
    • Critical Access Hospitals (CAHs) (TOB 85X)
      2. A MACs will pay these institutional providers based on the lower of the actual charge or 95% of the Average Wholesale Price (AWP) if you use,
    • Comprehensive Outpatient Rehabilitation Facilities (TOB 75X)
    • Independent RDFs (TOB 72X)
    • Indian Health Services (IHS),
      • Hospitals (TOBs 12X and 13X)
      • Hospices (TOBs 81X and 82X)
      • IHS CAHs (TOB 85X)

A MAC will hold  the claims they get before April 1, 2022, for mentioned below CPT codes,

  • HCPCS code 90677 with DOS on and after July 1, 2021
  • HCPCS code 90671 with DOS on or after July 16, 2021

A MAC will process the claims when Medicare systems are ready on April 4, 2022. Also, your MAC will initiate a mass adjustment for any claims that rejected with HCPCS 90677 with a DOS from July 1, 2021 to September 30, 2021. 

They will also adjust rejected claims with HCPCS code 90671 with dates of service from July 16, 2021 to March 31, 2022. These adjustments will occur after April 4, 2022.

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.

Influenza Virus Vaccine and Administration

 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 vaccine (IIV), split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use
  • 90672 Influenza virus vaccine, quadrivalent, live (LAIV4), for intranasal use
  • 90673 Influenza virus vaccine, trivalent (RIV3), derived from recombinant DNA, hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use
  • 90674 Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use
  • 90685 Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.25 mL dosage, for intramuscular use
  • 90686 Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.5 mL dosage, for intramuscular use
  • 90687 Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.25 mL dosage, for intramuscular use
  • 90688 Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.5 mL dosage, for intramuscular use
  • Q2035 Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Afluria)
  • Q2036 Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Flulaval)
  • Q2037 Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Fluvirin)
  • Q2038 Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Fluzone)
  • Q2039 Influenza virus vaccine, not otherwise specified

Administration CPT Codes

  • G0008  Administration of influenza virus vaccine
  • 90471   Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid)
  • 90472  Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure)
  • 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)

ICD-10 Codes

  • Z23

Who Is Covered

  • All Medicare beneficiaries

Frequency

  • Once per influenza season
  • Medicare covers additional flu shots if medically necessary

Medicare Beneficiary Pays

  • Copayment/coinsurance waived
  • Deductible waived

Pneumococcal Vaccine and Administration

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 Beneficiary Pays

  • Copayment/coinsurance waived
  • Deductible waived

Hepatitis B Virus (HBV) Vaccine and Administration

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

Covered ICD-10 Codes for CPT G0010

The specified below ICD codes are covered for CPT G0472 and may not be limited and some private payers have own specific guidelines,
  • B16.0 Acute hepatitis B with delta-agent with hepatic coma
  • B16.1 Acute hepatitis B with delta-agent without hepatic coma
  • B16.2 Acute hepatitis B without delta-agent with hepatic coma
  • B16.9 Acute hepatitis B without delta-agent and without hepatic coma
  • B17.0 Acute delta-(super) infection of hepatitis B carrier
  • B17.8 Other specified acute viral hepatitis
  • B17.9 Acute viral hepatitis, unspecified
  • B18.0 Chronic viral hepatitis B with delta-agent
  • B18.1 Chronic viral hepatitis B without delta-agent
  • B18.8 Other chronic viral hepatitis
  • B18.9 Chronic viral hepatitis, unspecified
  • B19.10 Unspecified viral hepatitis B without hepatic coma
  • B19.11 Unspecified viral hepatitis B with hepatic coma
  • K73.9 Chronic hepatitis, unspecified
  • K75.2 Nonspecific reactive hepatitis
  • Z28.04 Immunization not carried out because of patient allergy to vaccine or component
  • Z88.7 Allergy status to serum and vaccine

Who Is Covered

  • Certain Medicare beneficiaries at intermediate or high risk for contracting hepatitis B

NOTE: Medicare beneficiaries who are currently positive for antibodies for hepatitis B are not eligible for this benefit

Frequency

  • Scheduled dosages required

Medicare Beneficiary Pays

  • Copayment/coinsurance waived
  • Deductible waived

COVID-19 Vaccine CPT Updates for September and October 2021

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, preservative free, 100 mcg/0.5mL dosage, for intramuscular use

October '2021 

Accepted three Category I codes to report SARS-CoV-2 vaccine and immunization administration codes. 

Codes 91307, 0071A, and 0072A are used to report Pfizer COVID-19 vaccine and immunization administration for the tris-sucrose pediatric for patient age 5 through 11 years.

These codes were published on Oct. 6, 2021 and will be effective upon receiving Emergency Use Authorization or approval from the Food and Drug Administration.

September '2021

Accepted eight Category I codes to report SARS-CoV-2 vaccine and immunization administration codes. 

Codes 91305, 0051A, 0052A and 0053A are used to report Pfizer COVID-19 vaccine and immunization administration for the tris-sucrose formulation. 

Codes 0004A and 0054A are used to report Pfizer COVID-19 immunization administration booster doses for both available formulations. 

Codes 91306 and 0064A are used to report Moderna COVID-19 vaccine and immunization administration booster doses. 

Appendix Q has been updated to reflect these additions. These codes were published on Sept. 3, 2021 and will be effective upon receiving Emergency Use Authorization or approval from the Food and Drug Administration.

CMS Will Pay for COVID-19 Booster Shots

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 ways to ensure maximum access to COVID-19 vaccinations

New COVID-19 Vaccine Codes - September'2021

 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]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3 mL dosage, diluent reconstituted; booster dose.

Report 0001A, 0002A, 0003A, 0004A for the administration of vaccine 91300

0051A - 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, tris-sucrose formulation; first dose.

0052A - 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, tris-sucrose formulation; second dose.

0053A - 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, tris-sucrose formulation; third dose.

0054A - 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, tris-sucrose formulation; booster dose.

Report 0051A, 0052A, 0053A, 0054A for the administration of vaccine 91305

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/0.5 mL 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/0.5 mL dosage; second dose.

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.

Report 0011A, 0012A, 0013A, for the administration of vaccine 91301

0064A - 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, 50 mcg/0.25 mL dosage, booster dose.

Report 0064A for the administration of vaccine 91306

Expand Vaccination Requirements

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 illness and death from COVID-19 and are effective against the Delta variant.

CMS is developing an Interim Final Rule with Comment Period that will be issued in October.  

CMS expects certified Medicare and Medicaid facilities to act in the best interest of patients and staff by complying with new COVID-19 vaccination requirements.  

Health care workers employed in these facilities who are not currently vaccinated are urged to begin the process immediately. 

Facilities are urged to use all available resources to support employee vaccinations, including employee education and clinics, as they work to meet new federal requirements.

CMS Expands Medicare Payments for At-Home COVID-19 Vaccinations

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. 

Additional New CPT codes and Payments - COVID-19 Vaccine - Effective from 08/12/2021

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 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.

The specified below codes are effective date from August 12th, 2021.

Code
Description
Labeler name
Vaccine/procedure name
Effective date
Dosing interval
0003A
ADM SARSCOV2 30MCG/0.3ML3RD
Pfizer
Pfizer-Biontech COVID-19 Vaccine Administration – Third Dose
08/12/2021
28 days
0013A
ADM SARSCOV2 100MCG/0.5ML3RD
Moderna
Moderna COVID-19 Vaccine Administration – Third Dose
08/12/2021
28 days

Vaccine CPT codes Billing Guidelines

There are four different types of administration of vaccine CPT codes found.
  1. Pediatrics patients up to 18 years of age - CPT 90460 & 90461.
  2. Adult age patients - CPT 90471 & 90472.
  3. For Intranasal or oral route - CPT 90473 & 90474
  4. 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 administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid)

+90472 - Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure)

90473 - Immunization administration by intranasal or oral route; 1 vaccine (single or combination vaccine/toxoid)

+90474 - Immunization administration by the intranasal or oral route; each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure)

Examples

Diphtheria and Tetanus Toxoids Adsorbed vaccine 2 components administered to a pediatric patient and provided and counseling to the patient and parents by a physician.
  • The appropriate administration is billed with one each CPT 90460 and 90461 instead of a single code.
Fluzone Quadrivalent vaccine, a single-component vaccine, is administered to a pediatric patient and counseling is provided by the physician.
  • The appropriate administration code 90460 with only one unit.
Pentacel vaccine, a 5-component vaccine, is administered to a pediatric patient, and counseling is provided by the other qualified healthcare practitioner.
  • The appropriate administration CPT code 90460 with one unit and 4 units for CPT 90461
Flublok and Quadrivalent and Adacel vaccines are administered to an adult patient.
  • 90471and 90472 can be billed one unit for each code.

Five New Vaccine Codes Released - Effective July 1,2021

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.

ICD 10 CM Updates

New Rules for CPT Category III T Codes

Attach the Medical Records at initial Claim Submission Please note that when submitting your initial claim for any one of the CPT codes spec...