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Coding Guidelines: COVID-19 Vaccination and Treatment

With the emergence of the pandemic and the ruckus to manage the spread, a new set of codes were introduced that were associated with COVID-19 vaccinations and treatments. Let us look into some of these codes that were exclusively compiled for COVID-19.

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COVID-19 ICD-10 Codes

World Health Organization (WHO) created a list of codes just for COVID-19 cases (U07.1 COVID-19) and these were later put into effect by the Centers for Disease and Prevention in April 2020.

The Centers for Medicare and Medicaid Services (CMS) have created about 20 ICD-10-PCS codes for COVID-19 treatment options and vaccinations as of April 2020. Out of these, the administration of vaccines is covered by six codes, which include:

XW013S6 – Subcutaneous administration of the first dose of the COVID-19 vaccination using a percutaneous technique, group 6, new technology.
XW023S6 – Percutaneous administration of the first dose of the COVID-19 vaccine, group 6, new technology.
XW013U6 – COVID-19 vaccine administration through subcutaneous tissue, percutaneous method, group 6, new technology.
XW023U6 – Percutaneous administration of the COVID-19 vaccination with group 6 new technology.
XW013T6 – Subcutaneous administration of COVID-19 vaccination dose two using a percutaneous method and group 6, new technology.
XW023T6 – COVID-19 dose two administration using the percutaneous method and group 6 new technology.

The administration or infusion of medications, such as monoclonal antibodies and vaccinations for COVID-19 therapy, will be represented by the proposed PCS codes, according to CMS. The codes also cover vaccines from companies including BioNTech and Pfizer.

Medicare will, although, pay for the COVID-19 vaccine and its delivery independently from the Diagnosis-Related Group rate for hospitalized patients. The hospital must employ the appropriate CPT codes in order to get paid for giving the immunization to Medicare patients.

CPT Codes for COVID-19 Vaccination

The CPT codes for identifying COVID-19 vaccines have previously been made available by the American Medical Association (AMA).

Pfizer- BioNTech vaccine:

0001A (First dose code)
0002A (Second dose code)

Moderna vaccine:

0011A (First dose code)
0012A (Second dose code)

Receiving Payment for the Administration of Vaccines

Providers must utilize the correct medical codes for vaccination administration in order to be reimbursed. To complete vaccination coverage, CMS would pay physicians under Medicare Part B rather than Part D. Clinicians should not submit a Medicare claim for the vaccines as they are provided free of charge by the government.

Soon afterward, when organizations begin to bear expenditures for vaccination items, CMS will revise their reimbursement allowance. For both the Pfizer-BioNTech and Moderna vaccines, CMS has set a Payment allowance of $0.10.

The existing fee allowances for administering vaccines are $16.94 for the first dosage and $28.39 for the second. Medicare pays $28.39 for vaccines that need only one dosage.

For patients without insurance, the Provider Relief Fund reimburses the cost of giving the COVID-19 vaccination. The provider relief fund website states that providers are often compensated under Medicare prices, pending funds availability.

Billing for Vaccination

Providers must be enrolled in Medicare in order to bill for administering COVID-19 vaccination. Providers may use single/roster billing for a number of patients (more than 5 patients) to submit a single claim.

The respective bills, in particular, are acceptable regarding roster billing of institutional claims:

12X – Inpatient (Hospital)
22X – Part A of the stay in a skilled nursing facility (SNF) which was covered under Part B.
13X – Outpatient (Hospital)
23X – Outpatient (SNF)
81X – Hospice (Non-hospital)
82X – Hospice (Hospital)
34X – Part B of Home Health
85X – Hospital with Critical Access
75X – Facility for Comprehensive Outpatient Rehabilitation
72X – Independent Renal Dialysis Facility within a Hospital

COVID-19 has taken a huge toll on the entire world and healthcare stands on top of it. With the addition of newer codes, practices and hospitals are getting into the game of normalizing COVID-19 vaccines and treatments while ensuring proper reimbursements.

Practolytics has already incorporated the changes and additions to the system and is utilizing them effectively to bill the respective services for practices. Reach out to us and talk to our experts to learn more about our RCM services.