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COVID-19 Vaccine

The Centers For Medicare and Medicaid (CMS) Release Billing Guidelines for COVID-19 Vaccine

Medicaid /OHP

Trillium Community Health Plan (Trillium) is closely following advancements in the prevention and treatment of COVID-19, including vaccinations. As a healthcare provider, you will play an integral role as COVID-19 vaccines become available. We want to update you on important new information about vaccine coverage.

To prepare for vaccine administration, the Centers for Medicare and Medicaid (CMS) have published billing guidance (PDF) for Medicaid and Children’s Health Insurance Program (CHIP) providers.  Similar to other COVID-19 services, the vaccines will be offered at no cost to your patients. In addition:

  • Trillium will configure its systems to properly adjudicate COVID-19 vaccine-related claims, both for the vaccine and its administration, in accordance with Oregon’s coverage determinations for Medicaid beneficiaries 
  • Member liability will be $0
  • Non-participating provider pre-auth requirements will be waived
  • Provider reimbursement rates and emergency use authorizations (EUA) are all still pending and we will update you as that information becomes available

The American Medical Association (AMA) has published updates to the Current Procedural Terminology (CPT®) code set that includes new vaccine-specific codes to report immunizations for the novel coronavirus (SARS-CoV-2). The code set will continue to be updated as additional vaccines receive EUA approval by the U.S. Food & Drug Administration (FDA).

The following codes have been published:

Code Type

Code

Effective*

Home Vaccine Admin

M0201

6/8/2021

Pfizer Vaccine

91300

12/11/2020

Pfizer Vaccine Admin - 1st Dose

0001A

12/11/2020

Pfizer Vaccine Admin - 2nd Dose

0002A

12/11/2020

Pfizer Vaccine Admin - 3rd Dose

0003A

8/12/2021

Pfizer Vaccine Admin - Booster

0004A

9/22/2021

Moderna Vaccine

91301

12/18/2020

Moderna Vaccine Admin - 1st Dose

0011A

12/18/2020

Moderna Vaccine Admin - 2nd Dose

0012A

12/18/2020

Moderna Vaccine Admin - 3rd Dose

0013A

8/12/2021

Moderna Vaccine (Low Dose)

91306

10/20/2021

Moderna Vaccine (Low Dose) - Booster

0064A

10/20/2021

Janssen Vaccine

91303

2/27/2021

Janssen Vaccine Admin - Single Dose

0031A

2/27/2021

Janssen Vaccine Admin – Booster

0034A

10/20/21 

Pfizer Vaccine (Pediatric)

91307

10/29/2021

Pfizer Vaccine (Pediatric) Admin - 1st Dose

0071A

10/29/2021

Pfizer Vaccine (Pediatric) Admin - 2nd Dose

0072A

10/29/2021

*NEW* Pfizer Vaccine (Pediatric) Admin – 3rd Dose

0073A

1/3/2022

*NEW* Pfizer Vaccine (Ready to use)

91305

1/3/2022

*NEW* Pfizer Vaccine (Ready to use) Admin - 1st Dose

0051A

1/3/2022

*NEW* Pfizer Vaccine (Ready to use) Admin - 2nd Dose

0052A

1/3/2022

*NEW* Pfizer Vaccine (Ready to use) Admin - 3rd Dose

0053A

1/3/2022

*NEW* Pfizer Vaccine (Ready to use) Admin – Booster

0054A

1/3/2022

Additionally, CMS has also published a set of toolkits to help providers prepare to swiftly administer the vaccine once it is available. If you have any further questions about this upcoming vaccine or the COVID-19 services Trillium covers, please contact Provider Services at 1-877-600-5472 (TTY/TDD: 711).

Medicare Advantage

Trillium Medicare Advantage is closely following advancements in the prevention and treatment of COVID-19, including vaccinations. As a healthcare provider, you will play an integral role as COVID-19 vaccines become available. We want to update you on important new information about vaccine coverage.

To prepare for vaccine administration, the Centers for Medicare and Medicaid (CMS) have published billing guidelines for Medicare providers.  Similar to other COVID-19 services, the vaccines will be offered at no cost to your patients. However, please be aware the following billing specifics:

  • For Calendar Years (CYs) 2020 through 2022, Medicare payment for the COVID-19 vaccine and its administration for Medicare Advantage plan members will be made through the original fee-for-service Medicare program.
  • Trillium Medicare Advantage will not be able to process these claims.
  • Therefore, providers must submit claims for administering the COVID-19 vaccine to their CMS Medicare Administrative Contractor (MAC) using product-specific codes for each vaccine approved.

The American Medical Association (AMA) has published updates to the Current Procedural Terminology (CPT®) code set that includes new vaccine-specific codes to report immunizations for the novel coronavirus (SARS-CoV-2). The code set will continue to be updated as additional vaccines receive emergency use authorization (EUA) approval by the U.S. Food & Drug Administration (FDA).

The following codes have been published:

Code Type

Code

Effective*

Home Vaccine Admin

M0201

6/8/2021

Pfizer Vaccine

91300

12/11/2020

Pfizer Vaccine Admin - 1st Dose

0001A

12/11/2020

Pfizer Vaccine Admin - 2nd Dose

0002A

12/11/2020

Pfizer Vaccine Admin - 3rd Dose

0003A

8/12/2021

Pfizer Vaccine Admin - Booster

0004A

9/22/2021

Moderna Vaccine

91301

12/18/2020

Moderna Vaccine Admin - 1st Dose

0011A

12/18/2020

Moderna Vaccine Admin - 2nd Dose

0012A

12/18/2020

Moderna Vaccine Admin - 3rd Dose

0013A

8/12/2021

Moderna Vaccine (Low Dose)

91306

10/20/2021

Moderna Vaccine (Low Dose) - Booster

0064A

10/20/2021

Janssen Vaccine

91303

2/27/2021

Janssen Vaccine Admin - Single Dose

0031A

2/27/2021

Janssen Vaccine Admin – Booster

0034A

10/20/21 

Pfizer Vaccine (Pediatric)

91307

10/29/2021

Pfizer Vaccine (Pediatric) Admin - 1st Dose

0071A

10/29/2021

Pfizer Vaccine (Pediatric) Admin - 2nd Dose

0072A

10/29/2021

*NEW* Pfizer Vaccine (Pediatric) Admin – 3rd Dose

0073A

1/3/2022

*NEW* Pfizer Vaccine (Ready to use)

91305

1/3/2022

*NEW* Pfizer Vaccine (Ready to use) Admin - 1st Dose

0051A

1/3/2022

*NEW* Pfizer Vaccine (Ready to use) Admin - 2nd Dose

0052A

1/3/2022

*NEW* Pfizer Vaccine (Ready to use) Admin - 3rd Dose

0053A

1/3/2022

*NEW* Pfizer Vaccine (Ready to use) Admin – Booster

0054A

1/3/2022

 

Additionally, CMS has also published a set of toolkits to help providers prepare to swiftly administer the vaccine once it is available. If you have any further questions about this upcoming vaccine or the COVID-19 services Trillium Medicare Advantage covers, please contact Provider Services at 1-844-867-1156; (TTY: 711).