Coding for COVID-19 Immunizations
March 15, 2022
ACOG representatives to the American Medical Association (AMA) Current Procedural Terminology (CPT) Editorial Panel are working with vaccine developers and other physician societies to create vaccine and immunization administration codes for the COVID-19 vaccine as they submit Emergency Use Authorization (EUA) applications to the Federal Food and Drug Administration (FDA).
The AMA CPT Editorial Panel continues to update codes for the vaccines available. The codes represent both the vaccine product and the dose to allow for public health tracking via the claims. For the current list of codes, visit the AMA’s website.
Learn how to become a COVID-19 vaccinator.
Insurance coverage of COVID-19 Vaccines
The federal government is supplying the vaccines for distribution to facilities and practices that are enrolled as Medicare providers or COVID-19 immunization administrators. Enrollment allows the facility or practice to bill for the administration of the vaccine using the Vaccine Administration codes above. Reimbursement is geographically adjusted and based on the national payment rate. Starting on March 15, 2021, Medicare will pay approximately $40 for each dose in the vaccination series.
In June 2021, CMS announced the option for an additional payment for administering the COVID-19 vaccination in-home to Medicare beneficiaries. This was done in the hopes of reaching Medicare patients who have difficulty leaving their homes or are otherwise hard-to-reach. Providers can bill for this service utilizing the new HCPCS code M0201 for COVID-19 vaccine administration. This is to be used in conjunction with the appropriate CPT code for COVID-19 vaccine product and dose and can only be utilized if vaccination is the sole reason for the in-home patient visit. If more than one patient is being vaccinated at the same in-home visit, providers should bill the HCPCS code M0201 only once and bill additional CPT product/dose codes as necessary. Billing for in-home administration should be done only once per date, per service.
All Medicare patients are covered through the fee-for-service program, even if they are enrolled in a private Medicare plan. For all other payers, please reach out to the insurer for their billing and coverage policies.
In May 2021, the Department of Health and Human Services (HHS) launched the COVID-19 Coverage Assistance Fund (CAF) to cover the costs of administering COVID-19 vaccines to patients enrolled in health plans that either do not cover vaccination fees or cover them with patient cost-sharing. For more information on applying for these funds, refer to the CAF website.
However, due to a lack of sufficient funds, The Coverage Assistance Fund will only accept claims for vaccine administration until 11:59 p.m. ET on April 5, 2022.