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Coverage of the COVID-19 Vaccination for Independence Members (Updated March 1, 2021)
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Policy Impacted
Purpose
The purpose of this communication is to provide notice regarding information and procedure codes related to the coverage of SARS-CoV-2 (Coronavirus Disease 2019 (COVID-19)) vaccines and administration of the vaccines for Independence commercial members.
This policy communication addressing COVID-19 vaccine for Independence commercial members has been updated effective March 1, 2021 as follows:
- The following CPT codes were added: 91303, 0031A
Background
There is currently an outbreak of respiratory disease caused by a novel coronavirus, which has been detected both nationally and internationally. The virus has been named “SARS-CoV-2" and the disease it causes has been named “Coronavirus Disease 2019" (COVID-19).
Several pharmaceutical companies have developed vaccines that have shown efficacy in the prevention of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Distribution of COVID-19 vaccine will be controlled by the U.S Government, who will collaborate with local and state governments. COVID-19 vaccine will initially be distributed to health care providers at no charge.
Coverage Statement
The administration of COVID-19 vaccine is eligible for reimbursement consideration as a preventive service when the U.S. Food and Drug Administration (FDA) Emergency Use Authorization (EUA) criteria for the COVID-19 vaccine are met and the administration is in accordance with the Advisory Committee on Immunization Practices (ACIP).
According to the Centers for Disease Control and Prevention (CDC), the COVID-19 vaccine will initially be distributed at no charge. Therefore, additional reimbursement for the COVID-19 vaccine will not be provided by the Company.
REQUIRED DOCUMENTATION
The individual's medical record must reflect that the care provided is according to the pertinent FDA EUAs criteria and requirements. These medical records may include, but are not limited to, records from the professional providers' office, hospital, nursing home, home health agencies, therapies, and test reports.
The Company may conduct reviews and audits of services to our members, regardless of the participation status of the provider. All documentation must be made available to the Company upon request. Failure to produce the requested information may result in a denial for the service.
Coding
ADMINISTRATION OF COVID-19 VACCINE
0001A
0002A
0011A
0012A
0031A
COVID-19 VACCINE-THE VACCINE IS NOT ELIGIBLE FOR REIMBURSEMENT AS IT WILL BE PROVIDED TO HEALTHCARE PROVIDERS AT NO CHARGE
91300
91301
91303
