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Billing COVID-19 vaccine and administration FAQs
Last Modified: 10/25/2024
Location: FL, PR, USVI
Business: Part A, Part B
Note: Effective May 11, the federal Public Health Emergency (PHE) for the COVID-19 pandemic ended. Many of the flexibilities and waivers instituted during the PHE are now permanent or extended due to Congressional action, while others have expired as they were intended to address the PHE, not to permanently replace standing guidelines. Visit our
COVID-19 page for additional information.
Please see the FAQs below for billing COVID-19 vaccines and administrations.
Q1. What services can currently be billed for the vaccine and infusions?
A1. When COVID-19 vaccine and monoclonal antibody (mAb) doses are provided by the government without charge, you can only bill for the vaccine and mAb administrations. Don’t include the vaccine or drug codes on the claim when the vaccines and mAb are free.
Note: You may submit the billed amount as $0.01 if your software requires submission of the vaccine or infusion drug code with the administration.
Q2. For Part A billing, what revenue code should be used?
A2. The revenue codes 0771 (preventive care services, vaccine administration) or 0636 (pharmacy, drugs requiring detailed coding) should be used. Don’t include the vaccine or drug codes on the claim when the vaccines and mAb are free.
Q3. Can other services be billed on the same Part B claim as the administration?
A3. For individual claims, if the beneficiary receives services on the same day as the vaccine or infusion administration, the services can be billed if they are medically necessary and distinct, separate services from the vaccine or infusion. The services should be billed with applicable modifiers (i.e., modifier 25).
If you are billing the services on a roster bill claim, do not bill for any other services on the roster bill.
Q4. Does the CS modifier need to be on the administration claim?
A4. No, the CS modifier should not be reported on the vaccine and/or mAb infusion administration claims. Medicare beneficiaries pay nothing for the COVID-19 vaccine and mAb administrations. There is no deductible or copayment/coinsurance applied.
Q5. As the primary physician, is there a code we can bill to inform that the patient has received the COVID-19 vaccine?
A5. No, there is not a code for reporting the patient has received the vaccine. You can bill for the administration if you administer the vaccine.
Q6. Does a single Part A vaccine administration claim require an attending physician?
A6. An attending physician is required on all Part A claims including the COVID-19 vaccine and mAb infusion claims. If there is no attending physician information on the claim, it will be returned.
Q7. We are a critical access hospital (CAH) with a hospital-based clinic. Should we bill for the administration fees on the claim form for payment since we are cost-based or keep a roster for the free vaccine? A7. CAHs are listed among the providers of services who may administer and submit institutional claims to the MACs for vaccines. CAHs will follow the same instructions for any hospital facility and would bill on type of bill (TOB) 12x or 13x.
Q8. We are providing the vaccine and billing for the administration fee. Do we need to keep a roster for the vaccine even though it was free?
A8. No, you are not required to keep a roster of who the vaccine was administered to.
Q9. Is a clinical trial number required on claims for mAb?
A9. No, clinical trial numbers are not required on mAb claims.
Q10. Inpatient claims are usually billed with TOB 11X. Are vaccine administrations required to be submitted on TOB 12X claims?
A10. For hospitalized patients, payment for COVID-19 vaccines are made separately from the Diagnosis-Related Group (DRG) rate and not allowed on TOB 11X claims. The valid TOBs include 12X, 13X, 22X, 23X, 34X, 72X, 75X, 81X, 82X, and 85X.
Q11. Can specialists administer the vaccine or is it limited to primary care physicians?
A11. For non-institutional claims, the vaccine administration can be billed by these eligible professionals: physician, non-physician practitioners, clinic/group practice, pharmacy, and mass immunizer. The specialist can perform and bill the vaccine administration if they are enrolled in the Medicare program and meet eligibility requirements.
Q1. For Part B billing, are we required to submit a CMS-1500 claim form with the roster bill?
A2. Yes, the roster bill claim should include only the administration code.
Q1. What is required to enroll as a mass immunizer to roster bill?
A1. You must apply to become enrolled as a mass immunizer.
Q2. Do Part A enrolled providers need to enroll as a different provider type to submit roster bills?
A2. If the Part A provider will continue to bill Part A, then separate enrollment is not required.
If the billing will be submitted to Part B, you must separately enroll as a mass immunizer.
Q3. Do Part B enrolled providers need to enroll as a different provider type to submit roster bills?
A3. If the Part B provider is already enrolled as a different provider type, you must separately enroll as a mass immunizer.
If you have questions regarding Medicare processes, please
contact us.
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