How To Bill For COVID-19 (Coronavirus) Vaccine – CPT And Reimbursement?

There are two components of any vaccine billing. The cost of the drug and the cost of administration. The drug codes are based on the manufacturer and the administration codes are based on the manufacturer as well as a number of doses.

CPT code for Vaccine Drug

• • 91300 – Pfizer, COVID-19 vaccine, spike protein, preservative-free, 30mcg.0.3mL dose, diluent reconstituted for IM use
  • 91301 – Moderna, COVID-19 vaccine, spike protein, preservative-free, 30mcg.0.3mL dose, diluent reconstituted for IM use
  • 91303 – Janssen (J&J), COVID-19 vaccine, spike protein, preservative-free, 30mcg.0.3mL dose, diluent reconstituted for IM use

Note:

1. 1. 1. DO NOT bill for COVID-19 drug cost when the government provides the vaccine at no cost.
      2. DO NOT bill for out-of-pocket cost for administration when the vaccine is provided for free.

CPT codes for Vaccine Administration

1. 1. 0001A – Pfizer first dose Administration by IM injection of COVID-19 vaccine, 30mcg/0.3 mL.
   2. 0002A – Pfizer second dose Administration by IM injection of COVID-19 vaccine, 30mcg/0.3 mL
   3. 0011A – Moderna First dose Administration by IM injection of COVID-19 vaccine, 100mcg/0.5mL
   4. 0012A – Moderna second dose Administration by IM injection of COVID-19 vaccine, 100mcg/0.5mL
   5. 0031A – Janssen (J&J) Administration by IM injection of COVID-19 vaccine, adenovirus type 26 vector, 5×1010 viral particles/0.5mL, single dose

ICD-10 Diagnosis Code

• • Z23 – Encounter for immunization

Example to Bill for Pfizer’s Covid-19 Vaccine when vaccine purchased by practice:

First Dose For Pfizer Covid-19 Vaccine:

• • • Vaccine CPT Code – 91300
    • Administration Code: 0001A
    • ICD-10 Code: Z23
    • NDC Code: 59267-1000-01

Second Dose For Pfizer Covid-19 Vaccine:

• • • Vaccine CPT Code – 91300
    • Administration Code: 0002A
    • ICD-10 Code: Z23
    • NDC Code: 59267-1000-01

Example On How To Bill For Moderna’s Covid-19 Vaccine when vaccine purchased by practice:

First Dose For Moderna Covid-19 Vaccine:

• • • Vaccine CPT Code – 91301
    • Administration Code: 0011A
    • ICD-10 Code: Z23
    • NDC Code: 80777-0273-10

Second Dose For Moderna Covid-19 Vaccine:

• • • Vaccine CPT Code – 91301
    • Administration Code: 0012A
    • ICD-10 Code: Z23
    • NDC Code: 80777-0273-10

How Will The Reimbursement Process Work For COVID-19 Vaccine?

If Covid-19 Vaccine was provided by The Federal Government, there will be no reimbursement for the vaccine itself. So, use Vaccine CPT Code only IF the vaccine was NOT distributed by the government.

There will be reimbursement for the administration of the Covid-19 Vaccine, whose proposed reimbursement rates by CMS are as follow:

For Vaccines March 14, 2021, & Earlier

Moderna & Pfizer:

• • • 1^stDose Of Vaccine: $16.94
    • 2^ndDose Of Vaccine: $28.39

Janssen (J&J)

• • • Single Dose: $28.39

For Vaccines On Or After March 15, 2021

Moderna & Pfizer:

• • • 1^stDose Of Vaccine: $40
    • 2^ndDose Of Vaccine: $40

Janssen (J&J)

• • • Single Dose: $40

Note: Rates will differ and be adjusted as per geographical locations.

Disclaimer: This is general advice without any guarantees or warranties. Please consult your local MAC, insurance companies, billing department, and legal department before billing any insurance.[/vc_column_text][/vc_column][/vc_row]

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Information Summary

Below are some Important links for reference.

• • CPT Codes For COVID-19 Vaccine
  • Fact Sheet for Administering Vaccine
  • CMS Updated Payment & HCPCS Level 1 CPT Code Structure