Medicare Advantage

Coverage of COVID-19 Vaccination for Medicare Advantage Members (Updated November 3, 2021)


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 Medicare Advantage members.

This policy communication addressing COVID-19 vaccine for Medicare Advantage members has been updated retro-effective to October 20, 2021 as follows: 

  • ​The following CPT codes were added: ​0064A, 0071A, 0072A, 91306, 91307

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, which will collaborate with local and state governments. COVID-19 vaccine will initially be distributed to health care providers at no charge.​​​​​

Coverage Statement

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.​​​​​

Coding

CURRENT PROCEDURAL TERMI​NOLOGY (CPT) CODES ​

0001A 

0002A

0003A

0004A

​0011A 

0012A

0013A 

​0031A

0034A 

0064A

​0071A 

0072A

91300 

91301 

91303 

91306 

91307

HEALTHCARE COMMON PROCEDURE CODING SYSTEM (HCPCS) CODES 

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​

11/3/2021