DHS COVID-19 PROVIDER RESOURCES // OMAP
Medical Assistance Bulletin 01-20-62: Updates to the Medical Assistance Program Fee Schedule for Administration of SARS-CoV-2 Vaccines
Issued: May 24, 2020; Updated: January 26, 2021
Purpose
The purpose of this bulletin is to inform Medical Assistance (MA) providers about updates related to billing and payment for the administration of the novel coronavirus (SARSCoV-2) vaccines, effective December 1, 2020.
Scope
This bulletin applies to all physicians, certified registered nurse practitioners, certified nurse midwives, outpatient hospital clinics, independent medical surgical clinics, and licensed pharmacies enrolled in the MA Program who administer immunizations to MA beneficiaries in the Fee-for-Service delivery system (FFS) or through the MA managed care organizations (MCOs) in Physical Health HealthChoices and Community HealthChoices. Providers rendering services to MA beneficiaries in the managed care delivery system should contact the appropriate MCO with any billing questions.
On November 10, 2020, the Centers for Medicare & Medicaid (CMS) established new Current Procedure Terminology (CPT) codes for the administration of the SARS-CoV-2 vaccines manufactured by Pfizer, Inc. and Moderna, Inc. These codes are both distinct to each SARS-CoV-2 vaccine and the specific dose in the required schedule. This level of specificity offers the ability to track each vaccine dose, even when the vaccine product is not reported, such as when the vaccine is available at no cost.
On December 1, 2020, the Department added these CPT codes to the MA Program Fee Schedule for providers to use when billing the MA Program for the administration of the SARSCoV-2 vaccines manufactured by Pfizer, Inc. and Moderna, Inc. These codes are to be used by providers in both the FFS and managed care delivery systems to enable the Department to identify the specific SARS-CoV-2 vaccines that have been administered.
On December 24, 2020, the Department issued MAB 01-20-59, “Addition to the Medical Assistance Program Fee Schedule for Administration of SARS-CoV-2 Vaccines,” to inform providers about the addition of these codes. The MAB advised providers that the administration fee was $10.00.
On December 30, 2020, the Department issued MAB 01-20-60, “SARS-CoV-2 Vaccine Administration by Pharmacists,” announcing that the MA Program will pay pharmacies for the administration of the SARS-CoV-2 Vaccine in accordance with a licensed pharmacist’s authority to administer vaccines.
After discussion with medical providers and other stakeholders, the Department made the decision to increase the MA Program fee schedule rate to that of Medicare for the administration of the SARS-CoV-2 vaccines.
Additionally, on December 17, 2020, CMS established new CPT codes for the administration of the vaccine manufactured by AstraZeneca. In response, the Department will add these codes to the MA Program Fee Schedule, effective February 1, 2021, and available upon the approval of the Emergency Use Authorization by the U.S. Food and Drug Administration. These codes are to be used by providers in both the FFS and managed care delivery systems to enable the Department to identify the specific SARS-CoV-2 vaccines that have been administered.
Procedure
MA providers in both the FFS and managed care delivery systems are to bill for the administration of the SARS-CoV-2 vaccines to MA beneficiaries using the CPT codes below.
Vaccine Manufacturer
| Code
| Code Description
|
Pfizer, Inc
| 0001A
| Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (Coronavirus diseases [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3mL dosage, diluent reconstituted; first dose
|
0002A
| Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (Coronavirus diseases [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3mL dosage, diluent reconstituted; second dose
|
Moderna, Inc
| 0011A
| Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (Coronavirus diseases [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100
mcg/0.5mL dosage; first dose
|
0012A
| Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (Coronavirus diseases [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100
mcg/0.5mL dosage; second dose
|
AstraZeneca | 0021A
| Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, chimpanzee adenovirus Oxford 1 (ChAdOx1) vector, preservative free, 5x1010 viral particles/0.5mL dosage; first dose
|
0022A
| Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, chimpanzee adenovirus Oxford 1 (ChAdOx1) vector, preservative free, 5x1010 viral particles/0.5mL dosage; second dose
|
Attached is the “Updates to the Medical Assistance Program Fee Schedule: Procedure Codes for the Administration of SARS-CoV-2 Vaccine, Effective December 1, 2020”. The attachment identifies the procedure code, national code description, provider type, provider specialty, place of service, pricing and/or informational modifiers if applicable, and MA fee for the procedure codes for providers submitting MA FFS claims.
The MA Program fee schedule rate increase for the administration of the SARS-CoV-2, vaccine is effective December 1, 2020. The Department will reprocess claims submitted between December 1, 2020 and the issuance of this bulletin. Providers do not need to resubmit the claims.
The MA Program does not make direct payments to licensed pharmacists. Pharmacies may submit an 837 Professional (837P) claim to the MA Program for the administration of the vaccines by a pharmacist using the procedure codes as identified above. The billing and rendering provider for the administration fee claim should be the MA-enrolled pharmacy’s National Provider Identifier (NPI). An MA-enrolled prescriber’s NPI should be submitted in the referring provider field.
Providers may access the online version of the
MA Program Fee Schedule on the Department’s website.
As a reminder, MA providers may submit a separate NCPDP claim to the Department for the vaccine ingredient cost for MA eligible beneficiaries by indicating, on the claim submission, the appropriate National Drug Code and the units dispensed for the vaccine. Providers may access the online version of the
MA Drug Fee Schedule on the department’s website.
Providers may not bill the MA Program for a vaccine they receive at no cost, including SARS-CoV-2 vaccines purchased by the federal government.
Additional information and guidance pertaining to the COVID-19 vaccines can be found at the following links:
Attachment