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Guidelines and codes for COVID-19 vaccine administration

Will Capital Blue Cross cover COVID-19 vaccinations?

The vaccine itself will be paid for through funding authorized by the Coronavirus Aid, Relief, and Economic Security (CARES) Act. Administration of the vaccine by a provider (network and non-network during the PHE) will be covered for both commercial and Medicare Advantage members.

For Calendar Years 2020 and 2021, Medicare payment for the COVID-19 vaccine and its administration for beneficiaries enrolled in Medicare Advantage plans will be made through the original fee-for-service Medicare program. Submit claims for administering the COVID-19 vaccine to the CMS Medicare Administrative Contractor (MAC) using product-specific codes for each vaccine approved.

For Calendar Year 2022, Capital Blue Cross will pay for COVID-19 vaccine administration (including approved booster doses), without cost sharing, for our Medicare Advantage members.

For a provider to receive and administer the COVID-19 vaccine, the Department of Health requires that you:

  • Be credentialed/licensed in Pennsylvania
  • Sign and agree to the conditions in the CDC COVID-19 Vaccination Program Provider Agreement
  • Fully complete the CDC COVID-19 Vaccination Provider Profile form for each location where the COVID-19 vaccine will be administered

We encourage you to access the Department of Health's website for additional details.

What codes should we use to bill vaccine administration for COVID-19?

The American Medical Association announced the addition of CPT® codes to report immunization for the novel coronavirus (SARS-CoV-2). CPT® codes have been assigned to each coronavirus vaccine and to administration codes, which are unique to each vaccine.

The CPT® codes for the administration of the vaccine are as follows:

  • 0001A Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3mL dosage, diluent reconstituted; first dose (Pfizer vaccine)
  • 0002A Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3mL dosage, diluent reconstituted; second dose (Pfizer vaccine)
  • 0003A Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3mL dosage, diluent reconstituted; third dose (Pfizer vaccine) (effective 8/12/2021)
  • 0004A Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3 mL dosage, diluent reconstituted; booster dose (Pfizer vaccine)
  • 0011A Immunization administration by intramuscular injection of Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5mL dosage; first dose (Moderna vaccine)
  • 0012A Immunization administration by intramuscular injection of Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5mL dosage; second dose (Moderna vaccine)
  • 0013A Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5mL dosage; third dose (Moderna vaccine) (effective 8/12/2021)
  • 0031A immunization administration by intramuscular injection of SARS-CoV-2 (COVID-19) vaccine, DNA, spike protein, Ad26 vector, preservative free, 5x1010 viral particles/0.5 mL dosage, single dose (Johnson & Johnson vaccine)
  • 0034A Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, adenovirus type 26 (Ad26) vector, preservative free, 5x1010 viral particles/0.5 mL dosage; booster dose (Johnson & Johnson vaccine)
  • 0051A Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3 mL dosage, tris-sucrose formulation; first dose (Pfizer vaccine)
  • 0052A Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3 mL dosage, tris-sucrose formulation; second dose (Pfizer vaccine)
  • 0053A Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3 mL dosage, tris-sucrose formulation; third dose (Pfizer vaccine)
  • 0054A Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3 mL dosage, tris-sucrose formulation; booster dose (Pfizer vaccine)
  • 0064A Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 50 mcg/0.25 mL dosage, booster dose (Moderna vaccine)
  • 0071A Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 10 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation; first dose (Pfizer child vaccine)
  • M0201 COVID-19 vaccine administration inside a patient’s home; reported only one per individual home per dos when only COVID-19 vaccine admin is performed at the patient's home.
  • 0072A Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 10 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation; second dose (Pfizer child vaccine)
  • 0073A Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 10 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation; third dose (Pfizer child vaccine)

Note:

  • For vaccines that require multiple doses, communicate to patients to get both doses of the same vaccine.
  • Evaluation and Management codes should not be billed in addition to the admin unless it is for a separately identifiable service.
  • Bill for vaccine administration only.

Will Capital Blue Cross waive member cost share for the COVID-19 vaccine?

The vaccine itself will be paid for through funding authorized by the Coronavirus Aid, Relief, and Economic Security (CARES) Act, but administration of the vaccine by a provider (network and non-network during the PHE) will be covered with no member cost share for both commercial and Medicare Advantage.

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