This article will assist you with proper billing relating to COVID-19 vaccine and monoclonal antibody infusion. Beneficiary coinsurance and deductible are waived.
To bill single claims for COVID-19 vaccines and monoclonal antibodies, follow the instructions below.
Effective for dates of services on and after January 1, 2022, COVID-19 vaccines and mAbs provided to patients enrolled in a Medicare Advantage plan are to be billed to the Medicare Advantage plan.
For coding, effective dates and payment allowances for COVID-19 vaccines, refer to the CMS vaccine pricing - COVID-19 vaccines and monoclonal antibodies
Claim should include the proper billing of the ICD-10 diagnosis code, Z23, in item 21 or the EDI equivalent
Report the proper date of service.
Report the proper place of service.
Use the appropriate administration CPT or HCPCs code.
The diagnosis pointer should be used to indicate the primary diagnosis on the claim form.
Report the charge amount for each line item.
HCPCS M0201 (administration of pneumococcal, influenza, hepatitis b, and/or covid-19 vaccine inside a patient's home) can be billed if it meets the criteria outined in the following CMS resources:
For payment allowances and coding refer to the CMS vaccine pricing - COVID-19 vaccines and monoclonal antibodies and the CMS COVID-19 Monoclonal Antibodies webpages.
Claim should include the proper billing of the ICD-10 in item 21 or the EDI equivalent
Use appropriate diagnosis coded to highest level of specificity:
U071 - use as appropriate.
Report the proper date of service.
Report the proper place of service.
Use the appropriate administration CPT or HCPCs code
The diagnosis pointer should be used to indicate the primary diagnosis on the claim form.
Report the charge amount for each line item.
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