Coding for COVID-19 Vaccine Shots

Mary Madison, RN, RAC-CT, CDP
Clinical Consultant – Briggs Healthcare

After the emergency use authorization (EUA) or licensure of each COVID-19 vaccine product by FDA, CMS will identify the specific vaccine code(s), by dose if necessary, and specific vaccine administration code(s) for each dose for Medicare payment. CMS and the American Medical Association (AMA) are working collaboratively on finalizing a new approach to report use of COVID-19 vaccines.

If you intend to administer the COVID-19 vaccines, or the new monoclonal antibody bamlanivimab, or casirivimab and imdevimab, especially if you intend to roster bill these codes, please download and install the new release of PC-ACE (PDF). This release includes the coding structure, currently comprised of both a HCPCS Level I CPT code structure issued by the AMA and a HCPCS Level II code structure issued by CMS. Together, these codes support the administration of the COVID-19 vaccines and the monoclonal antibody infusions, as they become available; this structure includes the codes for bamlanivimab, and casirivimab and imdevimab. This code structure was developed to facilitate efficient claims processing for any COVID-19 vaccines and monoclonal antibody infusions that receive FDA EUA or approval. CMS and the AMA are working collaboratively regarding which codes to submit for COVID-19 vaccines and administration.  Most of these codes are not currently effective and not all codes will be used.  We will issue specific code descriptors in the future.  Effective dates for the codes for Medicare purposes will coincide with the date of the FDA EUA or approval.

*Updated* Get the most up to date list of billing codes, payment allowances and effective dates

Please share this blog with your billers so they are aware of what to expect in the future.

[Italics added by this author.]