Get Up to Speed on COVID-19 Vaccine Administration Coding and Pay

You MUST use a totally different system to get paid and code for COVID-19 vaccine administration; unlike other vaccines that use generic administration CPT codes, coronavirus vaccine reporting requires unique codes.

Get up to speed now on the available vaccines and how to report them correctly from your very first claim without over billing.

There are three different coronavirus vaccines available with different doses and schedules. The Pfizer and Moderna vaccines are already approved for administration in the United States, and the AstraZeneca vaccine (as of Dec 30) is expected to be approved very soon in the UK.

Created with ease of tracking and reporting in mind, each manufacturer has a different designated CPT code a series of alphanumeric vaccine administration codes which include administering the vaccine, counseling the patient, and updating the patient’s electronic record. These codes will track both the specific vaccine and which doses the patient receives.

Here are the codes for each of the different vaccines:

Pfizer Vaccine Code:

91300: Severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, mRNALNP, spike protein, preservative free, 30 mcg/0.3mL dosage, diluent reconstituted, for intramuscular use

Pfizer Administration Codes, 21-day dosing interval:

0001A: First dose, 30MCG/0.3ML DIL RECON
0002A: Second dose, SARSCOV2 30MCG/0.3ML DIL RECON

Moderna Vaccine Code

91301: Severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, mRNALNP, spike protein, preservative free, 100 mcg/0.5mL dosage, for intramuscular use

Moderna Administration Codes, 28-day dosing interval:

0011A: First dose, 100 MCG/0.5 ML
0012A: Second dose, 100 MCG/0.5 ML

AstraZeneca Vaccine Code

91302: Severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, chimpanzee adenovirus Oxford 1 (ChAdOx1) vector, preservative free, 5×1010 viral particles/0.5mL dosage, for intramuscular use

AstraZeneca Administration Codes, 28-day dosing interval:

0021A: First dose, 5X1010 VP/0.5 ML
0022A: Second dose, 5X1010 VP/0.5 ML

Payment Allowances for COVID-19 Vaccine Administration Coding

You can’t receive reimbursements for government-funded vaccines, but you can charge — and get reimbursed for — an administration fee for giving the shot. CMS has established Medicare payment allowance rates for vaccine administration which will be geographically adjusted for many providers. Currently, these are:

$16.94 for the first dose of a vaccine (CPT codes 0001A and 0011A)
$28.39 for the second dose (CPT codes 0002A and 0012A)
$28.39 for vaccines that require a single dose.

Other billing tips to keep in mind:

Free vaccines: Do not include vaccine codes on any claims for free vaccines.
Roster billing: You can bill a single claim for COVID-19 shot administration, or, if you administer five or more immunizations on the same day you have the option to submit a roster bill.
Copay: Your Medicare patients don’t pay anything—no copayment or deductible—for the COVID-19 immunization.
MA billing: If you participate in a Medicare Advantage (MA) plan, submit COVID-19 claims to Original Medicare for all patients enrolled in the MA plan in 2020 and 2021.
Medicaid payments: Medicaid reimbursement rates vary by state and whether the patient has managed care or fee-for-service coverage.
Commercial insurance reimbursement: Private payer rates will vary.
New releases: Keep your eye out for CMS updates on billing codes and payment allowances here.

IMPORTANT: New coding rules allow you to get paid $25 each time your nurse collects a NEW PATIENT specimen (this includes COVID-19 testing) – previously 99211 was only for established patients. However, you must successfully meet new CMS requirements to access this added reimbursement.

This recent change is only one example of coding rule modifications that could mean added reimbursement in your pocket for COVID-19 collection, testing and diagnosis. A slew of new codes (e.g., G2023, 87426, 99072, 0011A, U07.1, Z86.19), along with murky guidance from CMS, makes getting paid for these services especially tricky – unless you know how. This is where national coding expert and educator, Kim Huey MJ, CHC, CPC, CCS-P, PCS, CPCO, can help.

During her online training, “Get Paid $25/ea. for New Patient COVID-19 Testing With 99211,” Kim will lay out exactly how and when you should use the multitude of new CPT codes, ICD-10 codes, and modifiers to ensure you are paid more of what you are rightfully due for COVID-19 collection, testing and diagnosis.