CMS has released a set of toolkits for providers, states and insurers to help the health care system prepare and assist in swiftly administering these products once they become available. These resources are designed to increase the number of providers that can administer the products and ensure adequate reimbursement for administration in Medicare, while making it clear to private insurers and Medicaid programs their responsibility to cover these products at no charge to beneficiaries. This webpage provides the payment allowances and other related information for these products. For more information, review the COVID-19 provider toolkit.
COVID-19 Vaccines and Monoclonal Antibodies
Medicare Part B Payment for COVID-19 Vaccines and Certain Monoclonal Antibodies during the Public Health Emergency
Claim Coding, Submissions and Reimbursement (By United Healthcare)
Last update: December 2, 2020, 11:00 a.m. CST
Care providers are responsible for submitting accurate claims in accordance with state and federal laws and UnitedHealthcare’s reimbursement policies. When submitting COVID-19-related claims, follow the coding guidelines and guidance outlined below and review the CDC guideline for ICD-10-CM diagnosis codes.
Network physicians are required to use a network laboratory. UnitedHealthcare Preferred Lab Network providers meet higher standards for access, cost, quality and service standards.
RELATED STORY | TEXAS MEDICAL ASSOCIATION | DEC 2020
Health Plans to Cover Costs of Administering COVID-19 Vaccines | By David Doolittle
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.
As of Dec. 14, only UnitedHealthCare has published COVID-19 vaccine billing information, including specific details for Medicare Advantage and Medicaid patients.
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. The Centers for Medicare & Medicaid Service’s (CMS) website also provides details on codes, effective dates, and payment allowances.
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.
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