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 retro-effective to October 20, 2021 as follows:
- The following CPT codes were added: 0064A, 0071A, 0072A, 91306, 91307
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, which will collaborate with local and state governments. COVID-19 vaccine will initially be distributed to health care providers at no charge.
The administration of COVID-19 vaccine and additional doses are eligible for reimbursement consideration as a preventive service when the U.S. Food and Drug Administration (FDA) approval or 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).
When administration of COVID-19 vaccine occurs during a home visit, the administration of COVID-19 vaccine is considered not eligible for separate reimbursement from the home visit.
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.
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.
CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES
ADMINISTRATION OF COVID-19 VACCINE
COVID-19 VACCINE (THE VACCINE IS NOT ELIGIBLE FOR REIMBURSEMENT AS IT WILL BE PROVIDED TO HEALTHCARE PROVIDERS AT NO CHARGE)
HEALTHCARE COMMON PROCEDURE CODING SYSTEM (HCPCS) CODES
THE FOLLOWING CODE IS NOT ELIGIBLE FOR SEPARATE REIMBURSEMENT
M0201 COVID-19 vaccine administration inside a patient's home; reported only once per individual home, per date of service, when only COVID-19 vaccine administration is performed at the patient's home