Covid-19 has not left the world yet. It has been increasing in many parts of the world as a second wave. In 2021, governments have introduced the Covid-19 vaccine and started implementing it. Last year, CPT codes for corona virus were introduced by CMS and it had updates later on. Now that vaccine for the pandemic has started, CMS came up with new CPT codes for Covid-19 vaccines.
The American Medical Association approved two corona virus vaccine CPT Codes, 91300 and 91301. Two codes are used for better tracking, reporting, and analyzing data for the planning and allocation of vaccines for corona virus. The vaccine requires two doses. Four vaccine administration codes, 0001A, 0002A, 0011A, and 0012A have also been added. These administration codes are specific to each of the two vaccines and whether it is the first or second dose given to the patient.
This article explains the new CPT codes introduced for Covid-19 and how to bill them.
CPT codes for Covid-19:
91300
Severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) (Corona virus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative-free, 30 mcg/0.3mL dosage, diluent reconstituted, for intramuscular use. This COVID-19 vaccine is manufactured by Pfizer.
91301
Severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) (Corona virus disease [COVID-19]) vaccines, mRNA-LNP, spike protein, preservative-free, 100 mcg/0.5mL dosage, for intramuscular use. This COVID-19 vaccine is manufactured by Moderna.
Covid-19 Vaccine Administration CPT Codes:
Corona virus vaccine administration CPT codes are specific to vaccine and the dosage. Moreover, the vaccine administration codes report the work of administering the vaccine, counseling the patient or caregiver, and documenting the medical record.
0001A
Immunization administration by intramuscular injection of severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) (Corona virus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3mL dosage, diluent reconstituted; first dose. (The 0001A COVID-19 vaccine administration CPT code is for the first dose of the Pfizer vaccine only)
0002A
Immunization administration by intramuscular injection of severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) (Corona virus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3mL dosage, diluent reconstituted; second dose. (The 0002A COVID-19 vaccine administration CPT code is for the second dose of the Pfizer vaccine only)
0011A
Immunization administration by intramuscular injection of severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) (Corona virus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5mL dosage; first dose. (The 0011A COVID-19 vaccine administration CPT code is for the first dose of the Moderna vaccine only)
0012A
Immunization administration by intramuscular injection of severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) (Corona virus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5mL dosage; second dose. (The 0012A COVID-19 vaccine administration CPT code is for the second dose of the Moderna vaccine only)
How to bill for Covid-19 Vaccine:
- Accurate medical billing for Covid-19 vaccine is very significant and essential not only for reimbursement but governmental reporting purposes.
- Each vaccine has its own specificity based on the vaccine manufacturer. The vaccine administration code is also based on the manufacturer plus the number of doses.
- When healthcare professionals receive the COVID-19 Vaccine from the government to administer to patients, they should remember to only bill the vaccine administration codes while submitting the claims.
- Healthcare professionals should not include the vaccine CPT codes when the Corona virus vaccines are free.
How to bill for the Pfizer COVID-19 vaccine:
Pfizer COVID-19 Vaccine First Dose:
- Vaccine CPT: 91300
- Administration: 0001A
- ICD-10: Z23
NDC: 59267-1000-01
Pfizer COVID-19 Vaccine Second Dose:
- Vaccine CPT: 91300
- Administration: 0002A
- ICD-10: Z23
- NDC: 59267-1000-01
How to bill for the Moderna COVID-19 vaccine:
Moderna COVID-19 Vaccine First Dose:
- Vaccine CPT: 91301
- Administration: 0011A
- ICD-10: Z23
- NDC: 80777-0273-10
Moderna COVID-19 Vaccine Second Dose:
- Vaccine CPT: 91301
- Administration: 0012A
- ICD-10: Z23
- NDC: 80777-0273-10
ICD-10 Codes for COVID-19 Vaccinations
- The Centers for Medicare and Medicaid Services 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.
Covid-19 Reimbursement:
- A new interim final rule with a comment period makes sure that there exists Medicare reimbursement for the administration of a COVID-19 vaccine and healthcare provider’s use of innovative treatments for the novel corona virus, 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 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.
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. CPT codes are very essential while billing procedures. So, it’s very important to perform accurate CPT coding for maximum reimbursements.
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