DHS COVID-19 PROVIDER RESOURCES // OMAP
Medical Assistance Bulletin 01-21-03,
08-21-04, 09-21-02, 24-21-02, 31-21-03,
30-21-01, 33-21-02: Fee Increase for the Administration of SARS-CoV-2 Vaccines
Issued: May 1, 2020; Effective: March 15, 2021
Important Reminder: All providers must revalidate the Medical Assistance (MA) enrollment of each service location every five years. Providers should log into PROMISe™ to check the revalidation dates of each service location and submit revalidation applications at least 60 days prior to the revalidation dates. Enrollment (revalidation) applications may be found at https://www.dhs.pa.gov/providers/Providers/Pages/PROMISeEnrollment.aspx.
Purpose
The purpose of this bulletin is to advise Medical Assistance (MA) providers of fee increases for the administration of the novel coronavirus (SARS-CoV-2) vaccines, effective March 15, 2021.
Scope
This bulletin applies to all physicians, certified registered nurse practitioners, certified nurse midwives, outpatient hospital clinics, independent medical surgical clinics, renal dialysis centers, 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). MA beneficiaries in the managed care delivery system should contact the appropriate MCO with any billing questions.
Background
On January 26, 2021, the Department of Human Services (Department) issued MA Bulletin 01-20-62, “SARS-CoV-2 Vaccine Updates”, effective December 1, 2020, to advise MA providers about updates related to billing and payment for the administration of the SARSCoV-2 vaccines. The updates included the addition of new procedure codes for the administration of the SARS-CoV-2 vaccine manufactured by AstraZeneca, as well as the Department’s decision to increase the MA Program fee schedule rates to that of Medicare for the administration of the SARS-CoV-2 vaccines.
Discussion
On March 15, 2021, the Centers for Medicare & Medicaid Services (CMS) announced an increase to the Medicare payment amount for the administration of the SARS-CoV-2 vaccines to $40.00 for the administration of each dose of a SARS-CoV-2 vaccine. CMS explained the rate increase reflects updated information about the costs involved in administering the SARS-CoV-2 vaccine and the additional resources necessary to ensure the vaccine is administered safely and appropriately.
After discussion with medical providers and other stakeholders about the additional costs and resources necessary to administer the SARS-CoV-2 vaccine, 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, effective March 15, 2021.
Procedure
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.
| 001A
| 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
|
002A
| 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
|
Moderna, Inc.
| 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
|
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
|
AstraZeneca
| 0021A
| Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus diseases [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 diseases [COVID-19]) vaccine, DNA, spike protein, chimpanzee adenovirus Oxford 1 (ChAdOx1) vector, preservative free, 5x1010 viral particles/0.5mL dosage; second dose
|
Janssen Biotech, Inc.
| 0031A
| Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus diseases [COVID-19]) vaccine, DNA, spike protein, adenovirus type 26 (Ad26) vector, preservative free, 5x1010 viral particles/0.5mL dosage; single dose
|
Attached is the fee schedule entitled, “Fee Increase for the Administration of SARSCoV-2 Vaccines, Effective March 15, 2021”. 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 vaccines is effective March 15, 2021. The Department will reprocess claims submitted between March 15, 2021 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 type 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: