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DHS COVID-19 PROVIDER RESOURCES // OMAP

Addition to the Medical Assistance Program Fee Schedule for Administration of SARS-CoV-2 Vaccines

Issued: May 24, 2020; Effective Date: May 1, 2020

Purpose

The purpose of this bulletin is to inform Medical Assistance (MA) providers that the Department of Human Services (Department) added Current Procedural Terminology (CPT) codes 0001A, 0002A, 0011A, and 0012A to the MA Program Fee Schedule for the administration of the novel coronavirus (SARS-CoV-2) vaccines in response to the coronavirus disease 2019 (COVID-19) pandemic, effective December 1, 2020.

Scope

This bulletin applies to all physicians, certified registered nurse practitioners, certified nurse midwives, outpatient hospital clinics, and independent medical surgical clinics 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.

Background/Discussion

On November 10, 2020, in anticipation of the availability of a vaccine(s) for SARS-CoV2, the American Medical Association (AMA), in collaboration with the Centers for Medicare & Medicaid Services (CMS), established new CPT codes for the administration of the vaccines. These codes are both distinct to each coronavirus 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.

In response, the Department added CPT codes 0001A, 0002A, 0011A, and 0012A to the MA Program Fee Schedule for providers to use when billing the MA Program for the administration of the vaccine. 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

Upon the approval by the Food and Drug Administration of a vaccine, MA providers in both the FFS and managed care delivery systems are to bill for the administration of the SARS-CoV-2 vaccine 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, Ince​
​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

Attached is the “Addition to the Medical Assistance Program Fee Schedule: Procedure Codes for the Administration of SARS-CoV-2 Vaccines, 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. As indicated in the attachment, the MA Program fee schedule rate for the administration of the SARS-CoV-2 vaccine is $10.00.

Providers may access the online version of the MA Program Fee Schedule on the Department’s website.

MA providers may also bill the MA Program for the vaccine 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