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The Centers for Medicare and Medicaid (CMS) Release Billing Guidelines for COVID-19 Vaccine

Date: 01/05/21

Sunflower Health Plan is closely following advancements in the prevention and treatment of COVID-19, including vaccinations. As a healthcare provider, you will play an integral role as COVID-19 vaccines become available. We want to update you on important new information about vaccine coverage.

To prepare for vaccine administration, the Centers for Medicare and Medicaid (CMS) have published billing guidance for Medicaid and Children’s Health Insurance Program (CHIP) providers. Similar to other COVID-19 services, the vaccines will be offered at no cost to your patients. In addition:

  • Sunflower will configure its systems to properly adjudicate COVID-19 vaccine-related claims, both for the vaccine and its administration, in accordance with Kansas’s coverage determinations for Medicaid beneficiaries
  • Member liability will be $0
  • Non-participating provider pre-auth requirements will be waived
  • Provider reimbursement rates and emergency use authorizations (EUA) are all still pending and we will update you as that information becomes available

The American Medical Association (AMA) has published updates to the Current Procedural Terminology (CPT®) code set that includes new vaccine-specific codes to report immunizations for the novel coronavirus (SARS-CoV-2). The code set will continue to be updated as additional vaccines receive EUA approval by the U.S. Food & Drug Administration (FDA).

The following codes have been published as of November 10, 2020. However, they will not be billable until the specific vaccine receives official EUA approval.

Code CPT Short Descriptor Labeler Name Vaccine/Procedure Name
91300 SARSCOV2 VAC 30MCG/0.3ML IM Pfizer Pfizer-Biotech Covid-19 Vaccine
0001A ADM SARSCOV2 VAC 30MCG/0.3ML 1ST Pfizer Pfizer-Biotech Covid-19 Vaccine Administration – First Dose
0002A ADM SARSCOV2 VAC 30MCG/0.3ML 2ND Pfizer Pfizer-Biotech Covid-19 Vaccine Administration – Second Dose
91301 SARSCOV2 VAC 100MCG/0.5ML IM Moderna Moderna Covid-19 Vaccine
0011A ADM SARSCOV2 VAC 100MCG/0.5ML 1ST Moderna Moderna Covid-19 Vaccine Administration – First Dose
0012A ADM SARSCOV2 VAC 100MCG/0.5ML 2ND Moderna Moderna Covid-19 Vaccine Administration – Second Dose

Additionally, CMS has also published a set of toolkits to help providers prepare to swiftly administer the vaccine once it is available. If you have any further questions about this upcoming vaccine or the COVID-19 services Sunflower covers, please contact Customer Service at 1-877-644-4623.