January 7, 2021
Tips for administering, coding, and billing the COVID-19 vaccine
Provider enrollment to administer the vaccine
To administer COVID-19 vaccine, constituent products, and ancillary supplies, vaccination provider facilities and organizations must enroll in the federal COVID-19 Vaccination Program coordinated through their jurisdiction’s immunization program. Enrolled COVID-19 vaccination providers must be credentialed/licensed in the jurisdiction where the vaccination takes place, and sign and agree to the conditions in the CDC’s COVID-19 Vaccination Program Provider Agreement.
Each state has a draft plan for COVID-19 vaccine preparedness, addressing a variety of topics. That includes phases of distribution and allocation, identification of critical populations, and initial plan for prioritization of administration to different groups.
In Washington, to receive and administer the COVID-19 vaccine, providers must enroll in a federal vaccine distribution program, coordinated through the state immunization program unless they are part of a national chain registered directly with the CDC (e.g., major retail pharmacy chains). Washington state providers can enroll as COVID-19 vaccine providers.
Coding for COVID-19 vaccine shots
After the emergency use authorization (EUA) or licensure of each COVID-19 vaccine product by the FDA, CMS will identify the specific vaccine code(s), by dose if necessary, and specific vaccine administration code(s) for each dose for Medicare payment. CMS and the American Medical Association (AMA) are working collaboratively on finalizing a new approach to report the use of COVID-19 vaccines.
If you intend to administer the COVID-19 vaccines when they become available, or one of the antibody treatments (i.e., bamlanivimab, casirivimab-imdevimab), providers need to download and install the new release of PC-ACE. This release includes the coding structure, currently comprised of both a HCPCS Level I CPT code structure issued by the American Medical Association and a HCPCS Level II code structure issued by CMS. Together, these codes support the administration of the COVID-19 vaccines and the monoclonal antibody infusions, as they become available. This structure includes the codes for bamlanivimab.
This code structure was developed to facilitate efficient claims processing for any COVID-19 vaccines and monoclonal antibody infusions that receive FDA EUA or approval. CMS and the AMA are working collaboratively regarding which codes to submit for COVID-19 vaccines and administration. Most of these codes are not currently effective and not all codes will be used. We will issue specific code descriptors in the future. Effective dates for the codes for Medicare purposes will coincide with the date of the FDA EUA or approval.
Get the most up to date list of billing codes, payment allowances and effective dates.
Medicare provider enrollment required
If you’re not a Medicare provider, you must qualify and enroll as a mass immunizer (or other Medicare provider type that allows billing for administering vaccines), so you can bill for administering COVID-19 shots.
Enrolling over the phone as a mass immunizer is easy and quick — call your Medicare Administrative Contractor (MAC) enrollment hotline and provide your:
- Valid legal business name (LBN)
- National provider identifier (NPI)
- Tax identification number (TIN)
- Practice location and state license, if applicable
Temporary Medicare billing privileges
Medicare billing privileges through the Medicare Provider Enrollment Hotline are only temporary and granted on a provisional basis because of the public health emergency (PHE) declaration. When the COVID-19 PHE declaration is lifted, providers and suppliers will be asked to submit a complete CMS-855 enrollment application to establish full Medicare billing privileges. Failure to respond to the MAC’s request within 30 days of the notification will result in the deactivation of your temporary billing privileges. No payments can be made for services provided while your temporary billing privileges are deactivated.
To enroll in your state Medicaid program as well, contact your representative from the State Medicaid Agency Provider Enrollment Contact List.
Medicare Advantage coverage and reimbursement
For 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.
Medicare Advantage plans should inform their contracted providers about this coverage policy and direct them to submit claims for administering the COVID-19 vaccine to the CMS Medicare Administrative Contractor using product-specific codes for each approved vaccine.
Review our quick-reference process on enrollment.