Coverage of COVID-19 Vaccination for Medicare Advantage Members (Updated March 1, 2021)
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 Medicare Advantage members.
This policy communication addressing COVID-19 vaccine for Medicare Advantage members has been updated effective March 1, 2021 as follows:
- The following CPT codes were added: 91303, 0031A
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 and reimbursement for COVID-19 vaccine and vaccine administration for the Company's Medicare Advantage members will be processed through the local Medicare Administrative Contractor (MAC) for calendar years 2020 and 2021, as the COVID-19 vaccine has been identified as meeting Medicare's significant cost threshold. Therefore:
- Providers must submit all claims for COVID-19 vaccine and associated costs to the local MAC.
- Claims should not be submitted to the Medicare Advantage plan.