How to Bill Coronavirus Vaccine? — A Guide for Medical Billers

With the addition of Coronavirus to the illnesses list, now medical billing services have to compile claims for it. AMA (American Medical Association) recently approved two coronavirus vaccine-related CPT (Current Procedural Terminology) codes — 91300 and 91301.

These codes are used to track and allocate coronavirus vaccines. Another four codes 0001A, 0002A, 0011A, and 0012A are also added to the list for coronavirus administration. Generally, two doses are given to the individuals, and the administrative codes are specific to two approved vaccines manufactured by Pfizer and Moderna.

How Medical Billing Companies can Bill for Corona Vaccines?

Medical billers and coders need to be careful to compile claims as per the industry rules. This article is a guide to give an idea of what codes physicians can use for clinical documentation.

CPT Codes for Coronavirus Vaccine Documentation

Explanation of Coronavirus Vaccine Administrative Codes

The administrative codes describe how physicians can administer the coronavirus vaccines along with their dosage information.

Billing Instructions for the Corona CPT Codes

One thing to remember here is that accurate clinical documentation of the corona vaccine should be every physician’s priority. If they outsource medical billing services to a third party, there should be clear instructions regarding this. After all, accurate billing documentation is not crucial for reimbursements but also for governmental records.

For vaccines provided by the government to healthcare organizations, billing companies should not include CPT codes for the vaccine but only administrative codes. It is because the vaccine is free.

How Government Reimburses Physicians for Coronavirus Vaccines?

As the government provides vaccines to medical practices, there will be no reimbursement for the vaccine but only for the vaccine administration. To be exact, CMS (Centers for Medicare and Medicaid Services) has set the following reimbursement rate for physicians.

· First Dose: $16.94

· Second Dose: $28.39

Guidelines for Vaccine Shot Administration

Medical billing services can bill vaccine shots on a single claim for all patients, or they can send a roster bill for multiple patients at once.

Medicare Advantage Plan participants can submit their claims for all patients to Medicare. However, the patients must be Medicare beneficiaries for the years 2020 & 2021.

Instructions for Medicare Advantage Plan Contracted Provider

Medicare contracted healthcare providers or medical billers on their behalf must submit vaccine-related claims to Original Medicare as per the MAC (Medicare Administrative Contractors) instructions.

Instructions for Medicare and Other Types of Insurance Coverage

Ask about Medicare Part B insurance coverage for COVID-19 vaccine from patients who only have Part A Medicare coverage. If they have Part B insurance services, clinicians can submit vaccine claims to the relevant insurance company.

In case patients do not have a healthcare plan to cover the COVID-19 vaccine, billing services can ask for reimbursement from the Provider Relief Fund.

Moreover, payment can be adjusted as per the geographical location of the claims submitted by the medical billing services. Also, keep in mind that these rates are subject to change from time to time. Thus, medical billing services should keep an eye on the official guidelines to avoid inconsistencies in the claim processing.