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COVID-19 Vaccine Billing & Coding

A guide for dental practices billing medical insurance for COVID-19 vaccines & their administration

Check if your state is currently allowing dentists to administer COVID-19 vaccinations: https://success.ada.org/en/practice-management/patients/covid-19-vaccine-regulations-for-dentists-map 

Enrollment considerations:

Private/commercial insurers:

I.e. Aetna: “Aetna will cover COVID-19 vaccine administration fees without cost-sharing, for both in- and out-of-network providers, for Commercial and Medicaid members”

Medicare:

  1. If already enrolled as a Medicare Part B provider, no enrollment action needed to bill for the shot.
  2. If enrolled as Medicare DME supplier only, must also separately enroll as an institutional or non-institutional provider type, such as a mass immunizer, that can bill for the COVID-19 shot.
  3. If not currently enrolled in Medicare at all, must qualify and enroll as a mass immunizer or other Medicare provider type that allows billing for administering vaccines

* For 2 & 3 above, can call toll free hotline to enroll as mass immunizer over the phone: https://www.cms.gov/files/document/covid-19-mac-webpages-and-hotlines.pdf

* Note: Medicare billing privileges established via the Medicare Provider Enrollment Hotline are being granted on a provisional basis as a result of the public health emergency declaration and are temporary. Upon the lifting of the COVID-19 PHE declaration, providers and suppliers, will be asked to submit a complete CMS-855 enrollment application in order to establish full Medicare billing privileges.


Coding & Billing for vaccine and shot (administration):

 When COVID-19 vaccine 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 you participate in a Medicare Advantage Plan, submit your COVID-19 claims to Original Medicare for all patients enrolled in Medicare Advantage in 2020 and 2021.

“Medicare payment rates for COVID-19 vaccine administration will be $28.39 to administer single-dose vaccines. For a COVID-19 vaccine requiring a series of 2 or more doses, the initial dose(s) administration payment rate will be $16.94, and $28.39 for the administration of the final dose in the series.”

https://www.cms.gov/medicare/covid-19/medicare-covid-19-vaccine-shot-payment


ICD-10 Diagnosis:

Z23 - Encounter for immunization


Current codes for vaccine & shot: https://www.cms.gov/medicare/medicare-part-b-drug-average-sales-price/covid-19-vaccines-and-monoclonal-antibodies

Current codes for vaccine:

Code

CPT Short Descriptor

Labeler Name

Vaccine/Procedure Name

Payment Allowance

Effective Dates

91300

SARSCOV2 VAC 30MCG/0.3ML IM

Pfizer

Pfizer-Biontech Covid-19 Vaccine

$0.010*

12/11/2020 – TBD

91301

SARSCOV2 VAC 100MCG/0.5ML IM

Moderna

Moderna Covid-19 Vaccine

$0.010*

12/18/2020 – TBD

91302

SARSCOV2 VAC 5X10^10VP/.5MLIM

AstraZeneca

AstraZeneca Covid-19 Vaccine

$0.010*

xx/xx/xxxx – TBD

91303

SARSCOV2 VAC AD26 .5ML IM

Janssen

Janssen Covid-19 Vaccine

$0.010*

xx/xx/xxxx – TBD

 

Current codes for shot:

Code

CPT Short Descriptor

Labeler Name

Vaccine/Procedure Name

Payment Allowance

Effective Dates

0001A

ADM SARSCOV2 30MCG/0.3ML 1ST

Pfizer

Pfizer-Biontech Covid-19 Vaccine Administration – First Dose

$16.940**

12/11/2020 – TBD

0002A

ADM SARSCOV2 30MCG/0.3ML 2ND

Pfizer

Pfizer-Biontech Covid-19 Vaccine Administration – Second Dose

$28.390**

12/11/2020 – TBD

0011A

ADM SARSCOV2 100MCG/0.5ML1ST

Moderna

Moderna Covid-19 Vaccine Administration – First Dose

$16.940**

12/18/2020 – TBD

0012A

ADM SARSCOV2 100MCG/0.5ML2ND

Moderna

Moderna Covid-19 Vaccine Administration – Second Dose

 $28.390**

12/18/2020 – TBD

0021A

ADM SARSCOV2 5X10^10VP/.5ML 1

AstraZeneca

AstraZeneca Covid-19 Vaccine Administration – First Dose

$16.940**

xx/xx/xxxx – TBD

0022A

ADM SARSCOV2 5X10^10VP/.5ML 2

AstraZeneca

AstraZeneca Covid-19 Vaccine Administration – Second Dose

 $28.390**

xx/xx/xxxx – TBD

0031A

ADM SARSCOV2 VAC AD26 .5ML

Janssen

Janssen Covid-19 Vaccine Administration

$28.390**

xx/xx/xxxx – TBD

 

Current codes for Monoclonal Antibodies & their administration:

Code

CPT Short Descriptor

Labeler Name

Vaccine/Procedure Name

Payment Allowance

Effective Dates

 

 

Q0239

bamlanivimab-xxxx

Eli Lilly

Injection, bamlanivimab, 700 mg

 $0.010*

11/10/2020 – TBD

 

 

M0239

bamlanivimab-xxxx infusion

Eli Lilly

Intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoring

$309.600***

11/10/2020 – TBD

 

 
   
   

Q0243

casirivimab and imdevimab

Regeneron

Injection, casirivimab and imdevimab, 2400 mg

$0.010*

11/21/2020 – TBD

   

M0243

casirivi and imdevi infusion

Regeneron

intravenous infusion, casirivimab and imdevimab includes infusion and post administration monitoring

$309.600***

11/21/2020 – TBD

   

 

** Since it is anticipated that providers, initially, will not incur a cost for the product, CMS will update the payment allowance at a later date.  Providers should not bill for the product if they received it for free.