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The Centers for Medicare and Medicaid (CMS) Release Billing Guidelines for COVID-19 Vaccine

Date: 12/14/20

Superior HealthPlan is closely following advancements in the prevention and treatment of COVID-19, including vaccinations. As a health-care provider, you will play an integral role as COVID-19 vaccines become available. We want to update you on important new information about vaccine coverage.

To prepare for vaccine administration, the Centers for Medicare and Medicaid (CMS) have published billing guidance for Medicaid (STAR, STAR+PLUS, STAR Health and STAR Kids), Children’s Health Insurance Program (CHIP), Marketplace (Ambetter from Superior HealthPlan) and Medicare (Allwell from Superior HealthPlan) providers. Similar to other COVID-19 services, the vaccines will be offered at no cost to your patients. However, please be aware of the following billing specifics:

Medicaid and CHIP

  • Superior will configure its systems to properly adjudicate COVID-19 vaccine-related claims, for the administration of the vaccine, in accordance with Texas’s coverage determinations for Medicaid beneficiaries. 
  • Member liability will be $0.
  • Non-participating provider pre-auth requirements will be waived.
  • Provider reimbursement rates and emergency use authorizations (EUA) are all still pending and we will update you as that information becomes available.

Ambetter

  • Ambetter from Superior HealthPlan will configure its systems to properly adjudicate COVID-19 vaccine-related claims, both for the vaccine and its administration.
  • Member liability will be $0.
  • Non-participating provider pre-auth requirements will be waived.
  • Provider reimbursement rates and emergency use authorizations (EUA) are all still pending and we will update you as that information becomes available.

Medicare

  • For Calendar Years (CYs) 2020 and 2021, Medicare payment for the COVID-19 vaccine and its administration for Medicare Advantage plan members will be made through the original fee-for-service Medicare program.
  • Allwell from Superior HealthPlan will not be able to process these claims.
  • Therefore, providers must submit claims for administering the COVID-19 vaccine to their CMS Medicare Administrative Contractor (MAC) using product-specific codes for each vaccine approved.

The American Medical Association (AMA) has published updates to the Current Procedural Terminology (CPT®) code set that includes new vaccine-specific codes to report immunizations for the novel coronavirus (SARS-CoV-2). The code set will continue to be updated as additional vaccines receive EUA approval by the U.S. Food & Drug Administration (FDA).

The following codes have been published as of November 10, 2020. However, they will not be billable until the specific vaccine receives official EUA approval.

Code

CPT Short Descriptor

Labeler Name

Vaccine/Procedure Name

91300

SARSCOV2 VAC

30MCG/0.3ML IM

Pfizer

Pfizer-Biotech Covid-19 Vaccine

0001A

ADM SARSCOV2 VAC

30MCG/0.3ML 1ST

Pfizer

Pfizer-Biotech Covid-19 Vaccine

Administration – First Dose

0002A

ADM SARSCOV2 VAC

30MCG/0.3ML 2ND

Pfizer

Pfizer-Biotech Covid-19 Vaccine

Administration – Second Dose

91301

SARSCOV2 VAC

100MCG/0.5ML IM

Moderna

Moderna Covid-19 Vaccine

0011A

ADM SARSCOV2 VAC

100MCG/0.5ML 1ST

Moderna

Moderna Covid-19 Vaccine

Administration – First Dose

0012A

ADM SARSCOV2 VAC

100MCG/0.5ML 2ND

Moderna

Moderna Covid-19 Vaccine

Administration – Second Dose


Additionally, CMS has also published a set of toolkits to help providers prepare to swiftly administer the vaccine once it is available. If you have any further questions about this upcoming vaccine or the COVID-19 services Superior covers, please contact Provider Services at 1-877-391-5921.