Now that we have approved and recommended COVID-19 vaccines (Pfizer-BioNTech and Moderna), it’s time to execute the correct medical billing and coding strategy to sustain the country’s vaccination efforts properly.
These medical codes were nonexistent a year ago. Still, since we face a global pandemic, healthcare practitioners must quickly adapt to these new guidelines to accurately account for the novel coronavirus.
At Coronis Health, we understand hospital medical billing services’ complexity and embrace the critical importance of remaining constantly vigilant amid the changing chorus of hospital medical billing and coding requirements. We continue to adapt to the ever-changing environment that COVID-19 brings to the healthcare industry. We will make sure you are 100% compliant and provide you with tailored solutions and high-touch relationships you won’t find at a “Big Box” medical billing company.
CPT Codes for COVID-19 Vaccinations
The CPT Editorial Panel has approved a unique CPT code for each of the three coronavirus vaccines: Pfizer-BioNTech, Moderna, and AstraZeneca (awaiting authorization) as administration codes unique for each vaccine. For better tracking, reporting, and analysis, the new CPT codes clinically distinguish each coronavirus vaccine. The CPT codes are already made available before their public availability for facilities to update their electronic healthcare systems and learn how to execute billing for them efficiently.
For your reference, these are the same Category I CPT codes and long descriptors for the three vaccines, as indicated by the American Medical Association (AMA).
Pfizer-BioNTech and Moderna
- 91300: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative-free, 30 mcg/0.3mL dosage, diluent reconstituted, for intramuscular use.
- 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.
- 91302: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, chimpanzee adenovirus Oxford 1 (ChAdOx1) vector, preservative free, 5×1010 viral particles/0.5mL dosage, for intramuscular use
To document the administration of the vaccines, AMA has also created codes 0001A, 0002A, 0011A, and 0012A. Code 0001A describes the administration of the first dose of the Pfizer-BioNTech vaccine, while 0002A describes the second dose of the vaccine. For the Moderna vaccine, 0011A is used for the first dose and 0012A for the second dose.
Also stated by AMA, these CPT codes account for the actual work of administering the vaccine, in addition to all necessary counseling provided to patients or caregivers, as well as updating the electronic record. All the vaccine-specific CPT codes are available for use and effective upon each new coronavirus vaccine receiving emergency use authorization or approval from the FDA.
The complete list of codes and descriptors can be accessed here.
ICD-10 Codes for COVID-19 Vaccinations
The Centers for Medicare and Medicaid Services (CMS) has developed more than 20 International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS) codes for documenting COVID-19 treatments and vaccines, and six of these codes are for vaccine administration. Those exact codes are:
- XW013S6: Introduction of COVID-19 vaccine dose 1 into subcutaneous tissue, percutaneous approach, new technology group 6
- XW013T6: Introduction of COVID-19 vaccine dose 2 into subcutaneous tissue, percutaneous approach, new technology group 6
- XW013U6: Introduction of COVID-19 vaccine into subcutaneous tissue, percutaneous approach, new technology group 6
- XW023S6: Introduction of COVID-19 vaccine dose 1 into muscle, percutaneous approach, new technology group 6
- XW023T6: Introduction of COVID-19 vaccine dose 2 into muscle, percutaneous approach, new technology group 6
- XW023U6: Introduction of COVID-19 vaccine into muscle, percutaneous approach, new technology group 6
A new interim final rule with a comment period ensures that there will be Medicare reimbursement for the administration of a COVID-19 vaccine and provider use of innovative treatments for the novel coronavirus, just as long as the vaccines are authorized for emergency use or approved by the FDA.
The final rule also states that Medicare will pay providers $28.39 for the administration of a single-dose COVID-19 vaccine. But if an approved COVID-19 vaccine will require multiple doses, CMS will reimburse providers $16.94 for the initial dose and $28.39 for the administration of the final dose.
Other provisions indicated in the rule include:
- Both inpatient and outpatient reimbursement changes will only last for the duration of the COVID-19 public health emergency and come with some strings attached.
- COVID-19 hospitalizations that involve the use of certain new products authorized or approved to treat the virus will qualify for the enhanced payment, which will be the lesser of 65 percent of the operating outlier threshold for the claim or 65 percent of the cost of a COVID-19 stay beyond the operating Medicare payment, including the 20 percent add-on payment for COVID-19 hospitalizations authorized by the CARES Act.
- Medicare will reimburse hospitals separately for the use of drugs and biologicals.
- Medicaid reimbursement rates will vary by state and type of arrangement, for example, fee-for-service or managed care.
- Reimbursement rates will also vary among private payers. Federal regulations also require the payers to cover COVID-19 vaccines and administration even if they are provided through an out-of-network provider.
Hospital Billing Guidelines for COVID-19 Vaccine
According to CMS, you can either bill on single claims for COVID-19 shot administration or submit claims via a roster billing for multiple patients at one time. And when COVID-19 vaccine doses are provided by the government without charge, only bill for the vaccine administration. You must not include the vaccine codes on the claim when the vaccines are free.
If using roster billing in a hospital for institutional claims, you must administer shots to at least five patients on the same date, unless the institution is an inpatient hospital, says CMS. You can also submit individual claims.
The following are valid types of bills for roster billing:
- 12X, Hospital Inpatient (Medicare pays for the COVID-19 vaccine shots separately from the Diagnosis-Related Group rate and disallows billing them on 11X for hospitalized patients)
- 13X, Hospital Outpatient (Medicare pays for the COVID-19 vaccine shots separately from the Diagnosis-Related Group rate and disallows billing them on 11X for hospitalized patients)
- 22X, Skilled Nursing Facility (SNF) covered Part A stay (paid under Part B) & Inpatient Part B
- 23X, SNF Outpatient
- 34X, Home Health (Part B Only)
- 72X, Independent and Hospital-based Renal Dialysis Facility
- 75X, Comprehensive Outpatient Rehabilitation Facility
- 81X, Hospice (Non-hospital)
- 82X, Hospice (Hospital)
- 85X, Critical Access Hospital
CMS also indicates that providers need to be enrolled in Medicare to bill the public payer for COVID-19 vaccine administration.
How Coronis Can Help Your Hospital Medical Billing for COVID-19 Vaccinations
What makes hospital medical billing a challenging responsibility is keeping up with the changes in Medicare, Medicaid, and third-party payers. Facilities must stay up to date on the latest changes in regulations to maintain compliance and to ensure the submission of clean claims. Particularly, proper medical billing for the COVID-19 vaccinations is essential not only for reimbursement but also for government reporting purposes.
As a medical billing services company with more than 100 years of combined experience, Coronis Health is committed to constantly adapting to the healthcare industry’s dynamic landscape. We keep abreast of hospital billing guidelines, report on current and emerging health issues, and make sure your hospital billing services are aligned with new regulations. We will work as your partner and provide you with medical billing and coding solutions that ensure your collections are easy to manage and that denials are kept to an absolute minimum.
Schedule an Assessment for Our Medical Billing Services
Ensuring compliance with hospital billing guidelines can be a daunting and time-consuming task. Still, with the help of Coronis Health, you can effectively manage compliance. Get your facility COVID-19 vaccine ready with Coronis Health as your partner. Contact us today to schedule an assessment or request a free financial checkup.