KMAP BULLETIN: PHE COVID-19 Vaccine Administration Billing by Pharmacy DME Providers
Date: 02/16/21
KMAP GENERAL BULLETIN 21019 (PDF)
Effective February 1, 2021, and through the end of the Public Health Emergency (PHE), pharmacies who are also enrolled as Durable Medical Equipment (DME) providers can list their DME National Provider Identifier (NPI) as the “Referring/Ordering Provider” on the CMS-1500 (or electronic equivalent) billing form, for COVID-19 vaccine administration. All other COVID-19 billing rules and reimbursement during the PHE will apply.
| Billing Purpose | Ordering/Referring Provider | Billing Provider | Allowed | Not Allowed |
|---|---|---|---|---|
| Vaccine Administration Fee: Non-COVID vaccine | Protocol Provider PT/PS | 25/255 | X | |
| Vaccine Admin. Fee: COVID vaccine (Medicaid Only) | 25/255 | 25/255 | X | |
| Vaccine Admin. Fee: COVID vaccine (Medicaid Only) | 24/240 | 24/240 | X | |
| Vaccine Admin. Fee: COVID vaccine (Medicaid 2nd) | 24/240 | 24/240 | X | |
| Vaccine Admin. Fee: COVID vaccine (Medicaid 2nd) | 24/240 | 25/255 | X |
Note: The effective date of the policy is February 1, 2021. The implementation of State policy by the KanCare managed care organizations (MCOs) may vary from the date noted in the Kansas Medical Assistance Program (KMAP) bulletins. The KanCare Open Claims Resolution Log on the KMAP Bulletins page documents the MCO system status for policy implementation and any associated reprocessing.