The Texas Medical Association has been closely following how physicians and practices should bill the costs of administering COVID-19 vaccines once a vaccine is made more available throughout the state.
Individual health plans, Medicare, and Medicaid will cover COVID-19 vaccine administration fees without cost-sharing, TMA has learned. Meanwhile, the federal government will pay for each COVID-19 vaccine serum – even if it is part of a claim – at least through the end of the national public health emergency, TMA understands.
"Vaccine administration procedure codes 0001A and 0002A are benefits for Medicaid, Healthy Texas Women, Family Planning Program, and the Children with Special Health Care Needs Services Program for individuals who are 16 years of age and older," the Texas Medicaid & Healthcare Partnership said on its website. "Vaccine procedure code 91300 is informational only while the vaccine is distributed to providers free of charge."
The Centers for Medicare & Medicaid Service’s (CMS) website also provides details on codes, effective dates, and payment allowances. Medicare guidance indicates that claims for the COVID-19 vaccine should only include the vaccine administration. Do not include the vaccine on the claim when they are free.
Meanwhile, UnitedHealthCare and Aetna have published COVID-19 vaccine billing information, including specific details for Medicare Advantage and Medicaid patients. UHC has also stated they will be following CMS claim instructions.
Cigna published their COVID-19 vaccine billing information that includes guidance on reimbursing administration of the vaccine according to the national CMS rates. According to the Cigna’s general billing policy, drugs should be billed on the claims with one penny.
Humana has not officially posted a billing guide for the COVID-19 vaccines, but says the vaccine will be covered at no additional cost during the public health emergency. Both in-network and out-of-network providers will be reimbursed.
For Blue Cross and Blue Shield of Texas (BCBSTX), the vaccine should be billed with at least a penny on each claim, a BCBSTX representative told TMA.
Physicians and practice staff should watch for updates from other major payers.
More than 100 hospitals in 34 Texas counties will receive doses of Pfizer’s COVID-19 vaccine, state health officials have announced. The initial allotment is part of the first stage of the state’s vaccine distribution plan, which prioritizes certain essential health care workers and vulnerable populations.
Throughout the COVID-19 pandemic, health plans in Texas have adopted various temporary deadlines and extensions, including cost-share waivers for COVID-19 screening, testing, and treatment. TMA has been tracking those waivers as well as state and federal deadlines and program extensions.
Find more information, tools, and resources on the COVID-19 Resource Center and Practice Viability pages, which are updated frequently.