COVID-19 Vaccines and Coverage
In the face of the COVID-19 pandemic, pharmaceutical companies have moved to produce vaccines. The Food and Drug Administration (FDA) awarded an Emergency Use Authorization (EUA) to two companies for their vaccines: Pfizer on Dec. 11, 2020, and Moderna
on Dec. 18, 2020.
Federal and state health officials are working with the medical community to distribute the COVID-19 vaccine.
Rollout Projections: The federal government is working with drug companies to have 300 million doses
by the end of January 2021. Health care workers and long-term care facility residents have priority access. The Centers for Disease Control and Prevention (CDC) projected rollout is below:
Phase |
Access |
Projected Start Date |
---|---|---|
1a |
Health care workers |
December 2020 |
1b |
Long-term care facility residents via federal partnership with Walgreens and CVS |
December 2020 |
2 |
Vaccinate broader population with the help of retail pharmacies |
January 2021 |
3 |
Integrate vaccination into routine vaccine programs like influenza vaccine |
Fall 2021 |
Initially, the federal government will pay for the vaccine. Blue Cross and Blue Shield of Oklahoma (BCBSOK), or self-funded groups, will cover administration of the vaccine as noted below:
Fully insured:
- Vaccine and administration covered as a preventive service with no cost-share to members at in-network providers
- Vaccine and administration covered with no cost-share to members if delivered at out-of-network providers through the end of the public health emergency
Self-funded employer groups:
- Non-grandfathered self-funded employer groups - vaccine and administration covered as a preventive service with no cost-share to members at in-network providers
- Vaccine and administration covered at no cost-share to members at out-of-network providers through the end of the public health emergency
- Self-funded employer groups that don't cover preventive vaccines through their pharmacy benefit must cover the vaccine through their medical benefit
- Grandfathered plans are not required to cover preventive services, including the COVID-19 vaccine
Medicare Advantage and Medicare Supplement
- For 2020 and 2021, Medicare payment for the COVID-19 vaccine and its administration will be through the original fee-for-service Medicare program.
- Submit claims for administering the COVID-19 vaccine to the CMS Medicare Administrative Contractor (MAC) using product-specific codes for each vaccine approved.
- Members will have no cost-sharing on vaccines through Dec. 31, 2021.
Reimbursement:
- In-network providers will be reimbursed for the administration fee based on contracted rates.
- Out-of-network providers will be reimbursed based on established OON reimbursement policy that follows Medicare rates.
Balance billing: Providers are prohibited from billing patients for the vaccine or its administration, including balance billing, if the provider received the vaccine at no cost from the government.
Coding claims: CMS and the American Medical Association (AMA) have identified the codes to use in submitting claims. For more information, see CMS' guidance .
Code |
Use |
Description |
---|---|---|
91300 |
Vaccine |
Pfizer-Biontech Covid-19 Vaccine SARSCOV2 VAC 30MCG/0.3ML IM |
0001A |
Admin |
Pfizer-Biontech Covid-19 Vaccine Administration – First Dose ADM SARSCOV2 30MCG/0.3ML 1ST |
0002A |
Admin |
Pfizer-Biontech Covid-19 Vaccine Administration – Second Dose ADM SARSCOV2 30MCG/0.3ML 2ND |
91301 |
Vaccine |
Moderna Covid-19 Vaccine SARSCOV2 VAC 100MCG/0.5ML IM |
0011A |
Admin |
Moderna Covid-19 Vaccine Administration – First Dose ADM SARSCOV2 100MCG/0.5ML1ST |
0012A |
Admin |
Moderna Covid-19 Vaccine Administration – Second Dose ADM SARSCOV2 100MCG/0.5ML2ND |
Dosage: Candidate vaccines may require one or two doses. The Pfizer and Moderna vaccines require two doses.
More information:
- CDC COVID-19 Vaccination Program Interim Playbook
for Jurisdiction Operations
- Provider Relief Fund
– for reimbursement for administering the COVID-19 vaccine to the uninsured
- CMS guidance
on Medicare billing for the COVid-19 vaccine administration
We continue to monitor information provided by the CDC and other government and health officials. We'll provide updates when we have them. For the latest information on COVID-19, we recommend visiting the CDC's COVID-19 website .
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