Reimbursement

There are two components of any vaccine billing. The cost of the drug and the cost of administration. The drug codes are based on the manufacturer and the administration codes are based on the manufacturer as well as a number of doses. CPT code for Vaccine Drug 91300 – Pfizer, COVID-19 vaccine, spike protein, preservative-free, 30mcg.0.3mL dose, diluent reconstituted for IM use 91301 – Moderna, COVID-19 vaccine, spike protein, preservative-free, 30mcg.0.3mL dose, diluent reconstituted for IM use 91303 – Janssen (J&J), COVID-19 vaccine, spike protein, preservative-free, 30mcg.0.3mL dose, diluent reconstituted for IM use Note: DO NOT bill for COVID-19 drug cost when the government provides the vaccine at no cost. DO NOT bill for out-of-pocket cost for administration when the vaccine is provided for free. CPT codes for Vaccine Administration 0001A – Pfizer first dose Administration by IM injection of COVID-19 vaccine, 30mcg/0.3 mL. 0002A – Pfizer second dose Administration by IM injection of COVID-19 vaccine, 30mcg/0.3 mL 0011A – Moderna First dose Administration by IM injection of COVID-19 vaccine, 100mcg/0.5mL 0012A – Moderna second dose Administration by IM injection of COVID-19 vaccine, 100mcg/0.5mL 0031A – Janssen (J&J) Administration by IM injection of COVID-19 vaccine, adenovirus type 26 vector, 5×1010 viral particles/0.5mL, single dose ICD-10 Diagnosis Code Z23 – Encounter for immunization Example to Bill for Pfizer’s Covid-19 Vaccine when vaccine purchased by practice: First Dose For Pfizer Covid-19 Vaccine: Vaccine CPT Code – 91300 Administration Code: 0001A ICD-10 Code: Z23 NDC Code: 59267-1000-01 Second Dose For Pfizer Covid-19 Vaccine: Vaccine CPT Code – 91300 Administration Code: 0002A ICD-10 Code: Z23 NDC Code: 59267-1000-01 Example On How To Bill For Moderna’s Covid-19 Vaccine when vaccine purchased by practice: First Dose For Moderna Covid-19 Vaccine: Vaccine CPT Code – 91301 Administration Code: 0011A ICD-10 Code: Z23 NDC Code: 80777-0273-10 Second Dose For…

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HHS has launched an online portal on April 6, 2020 for providers to submit claims for treatment and testing of COVID-19 uninsured patients. An unprecedented number of Americans have filed for unemployment claims and according to data released last Friday, the unemployment rate is at 14.5% which is highest since the great depression. Since a majority of Americans receive their health insurance from their employers, many of them have lost their health insurance along with their jobs. Besides, the COVID-19 virus does not care if you have insurance or not. Congress understands this and they passed the Families First Coronavirus Response Act which allocated $1 billion to reimburse providers to treat uninsured patients with COVID-19. The Coronavirus Aid, Relief and Economic Security (CARES) Act earmarked $100 billion in relief funds for providers, with a requirement that the funds be used to pay for the expenses of un-insured COVID-19 patients. We do not know and when the funding for this program will run out so it is important that if you have provided COVID-19 testing or treatment for uninsured patients with COVID-19 diagnosis on or after February 4, 2020, submit your claims as soon as possible. HHRS has selected United health group as the sole administrator of the program. Who can submit claims for COVID-19 Testing or Treatment of Un-insured patients? Reimbursement will be made for providing services and testing of all claims with primary COVID-19 diagnosis that would generally be covered by Medicare including Hospitals (In-patient) Private practices (Outpatient/Ambulatory care) Laboratories DME SNF / Long term Acute Care (LTAC) How much payment will I receive? Payment will be based on current Medicare rates unless otherwise specified. There is no guidance on how long the funding for the program will last. How to submit claims for COVID-19 testing or treatment of un-insured