Last Modified: 7/13/2022
Business: Part A, Part B
If a qualifying face-to-face encounter occurs at the time the vaccine or infusion was administered, the FQHC should include the cost of the COVID-19 vaccine or mAb administration to the encounter charge on the bill.
Reporting of these codes are informational only when billed with an encounter and reimbursement is made for the encounter only.
The vaccine or mAb administration should be included on the cost report and will be reimbursed at the time of cost settlement.
When COVID-19 vaccine and mAb doses are provided by the government without charge, only bill the administration. Do not include the vaccine or drug on the claim when received for free (do not show a $0.00 on claim.)
Administration of the COVID-19 vaccine or mAb does not count as a face to face encounter when it is the only service provided. In this scenario, a claim should not be submitted. If the administration is billed without an encounter visit, the claim will be returned to provider as unprocessable.
Independent and provider-based RHCs do not include charges for COVID-19 vaccine or mAb infusion administration on a claim. Reimbursement is made at the time of cost settlement. Claims will process with $0 payment when submitted with only the vaccine, drug, or administration.
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.