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Last Modified: 4/16/2024 Location: FL, PR, USVI Business: Part A

COVID-19 vaccine and monoclonal antibody billing for Part A providers

This article will assist Medicare Part A providers with proper billing relating to COVID-19 vaccine and monoclonal antibody (mAb) infusion. Beneficiary coinsurance and deductible are waived.

How to bill for COVID-19 vaccines and monoclonal antibodies

For billing single claims for COVID-19 vaccines and monoclonal antibodies, follow the instructions in the article below.
For roster billing and centralized billing, reference the Medicare billing for COVID-19 vaccine shot administration external link page.
When COVID-19 vaccine and monoclonal antibody doses are provided by the government without charge, only bill for the vaccine administration. Don't include the vaccine codes on the claim when the vaccines are free.
If the patient is enrolled in a Medicare Advantage (MA) plan, submit your COVID-19 vaccine and monoclonal antibody infusion claims to Original Medicare in 2020 and 2021. On or after January 1, 2022, claims for vaccine or mAb administrations for Medicare Advantage enrollees should be submitted to the Medicare Advantage plan. For services provided to Medicare Advantage enrollees on or after January 1, 2022, contact the Medicare Advantage for guidance on coverage and billing.
These codes will not apply to skilled nursing facility consolidated billing (SNF CB) edits.
The types of bill (TOBs) to report for the COVID-19 vaccine and mAb infusion on the Part A claim form, or electronic equivalent, are:
Inpatient Part B
Hospital -- 12X
SNF -- 22X
Outpatient
Hospital -- 13X
SNF -- 23X
End stage renal disease -- 72X
Comprehensive outpatient rehabilitation facility -- 75X
Critical access hospital -- 85X

COVID-19 vaccines and administration

Revenue codes:
0771 -- Preventive care services, vaccine administration
0636 -- Pharmacy, drugs requiring detailed coding
Vaccine and administration codes:

Code
Description
Labeler name
Vaccine/procedure name***
Effective date
91300*
SARSCOV2 VAC 30MCG/0.3ML IM
Pfizer
Pfizer-BioNTech COVID-19 Vaccine (Aged 12 years and older) (Purple Cap)
12/11/2020-04/18/2023
0001A
ADM SARSCOV2 30MCG/0.3ML 1ST
Pfizer
Pfizer-BioNTech COVID-19 Vaccine (Purple Cap) Administration – First Dose
12/11/2020-04/18/2023
0002A
ADM SARSCOV2 30MCG/0.3ML 2ND
Pfizer
Pfizer-BioNTech COVID-19 Vaccine (Purple Cap) Administration – Second Dose
12/11/2020-04/18/2023
0003A
ADM SARSCOV2 30MCG/0.3ML 3RD
Pfizer
Pfizer-BioNTech COVID-19 Vaccine (Purple Cap) Administration – Third Dose
08/12/2021-04/18/2023
0004A
ADM SARSCOV2 30MCG/0.3ML BST
Pfizer
Pfizer-BioNTech COVID-19 Vaccine (Purple Cap) Administration – Booster
09/22/2021-04/18/2023
91301*
SARSCOV2 VAC 100MCG/0.5ML IM
Moderna
Moderna COVID-19 Vaccine (Aged 12 years and older) (Red Cap)
12/18/2020-04/18/2023
91318
SARSCOV2 VAC 3MCG TRS-SUC IM
Pfizer
Pfizer-BioNTech COVID-19 Vaccine 2023-2024 Formula (Yellow Cap)
09/11/2023
91319
SARSCV2 VAC 10MCG TRS-SUC IM
Pfizer
Pfizer-BioNTech COVID-19 Vaccine 2023-2024 Formula (Blue Cap)
09/11/2023
91320
SARSCV2 VAC 30MCG TRS-SUC IM
Pfizer
COMIRNATY (COVID-19 Vaccine, mRNA) 2023-2024 Formula
09/11/2023
91321
SARSCOV2 VAC 25 MCG/.25ML IM
Moderna
Moderna COVID-19 Vaccine 2023-2024 Formula
09/11/2023
91322
SARSCOV2 VAC 50 MCG/0.5ML IM
Moderna
SPIKEVAX 2023-2024 Formula
09/11/2023
0011A
ADM SARSCOV2 100MCG/0.5ML1ST
Moderna
Moderna COVID-19 Vaccine (Red Cap) Administration – First Dose
12/18/2020-04/18/2023
0012A
ADM SARSCOV2 100MCG/0.5ML2ND
Moderna
Moderna COVID-19 Vaccine (Red Cap) Administration – Second Dose
12/18/2020-04/18/2023
0013A
ADM SARSCOV2 100MCG/0.5ML3RD
Moderna
Moderna COVID-19 Vaccine (Red Cap) Administration – Third Dose
08/12/2021-04/18/2023
91303*
SARSCOV2 VAC AD26 .5ML IM
Janssen
Janssen COVID-19 Vaccine (Aged 18 years and older)
02/27/2021-06/01/2023
0031A
ADM SARSCOV2 VAC AD26 .5ML
Janssen
Janssen COVID-19 Vaccine Administration – First Dose
02/27/2021-06/01/2023
0034A
ADM SARSCOV2 VAC AD26 .5ML B
Janssen
Janssen COVID-19 Vaccine Administration - Booster
10/20/2021-06/01/2023
0044A
ADM SARSCOV2 5MCG/0.5ML BST
Novavax
Novavax COVID-19 Vaccine Administration - Booster
10/19/2022-10/03/2023
91304*
SARSCOV2 VAC 5MCG/0.5ML IM
Novavax
Novavax COVID-19 Vaccine, Adjuvanted (Aged 12 years and older)
07/13/2022
0041A
ADM SARSCOV2 5MCG/0.5ML 1ST
Novavax
Novavax COVID-19 Vaccine, Adjuvanted Administration – First Dose
07/13/2022-10/03/2023
0042A
ADM SARSCOV2 5MCG/0.5ML 2ND
Novavax
Novavax COVID-19 Vaccine, Adjuvanted Administration – Second Dose
07/13/2022-10/03/2023
91305*
SARSCOV2 VAC 30 MCG TRS-SUCR
Pfizer
Pfizer-BioNTech Covid-19 Vaccine Pre-Diluted (Aged 12 years and older) (Gray Cap)
01/03/2022-04/18/2023
0051A
ADM SARSCV2 30MCG TRS-SUCR 1
Pfizer
Pfizer-BioNTech COVID-19 Vaccine Pre-Diluted (Gray Cap) Administration - First dose
01/03/2022-04/18/2023
0052A
ADM SARSCV2 30MCG TRS-SUCR 2
Pfizer
Pfizer-BioNTech COVID-19 Vaccine Pre-Diluted (Gray Cap) Administration - Second dose
01/03/2022-04/18/2023
0053A
ADM SARSCV2 30MCG TRS-SUCR 3
Pfizer
Pfizer-BioNTech COVID-19 Vaccine Pre-Diluted (Gray Cap) Administration - Third dose
01/03/2022-04/18/2023
0054A
ADM SARSCV2 30MCG TRS-SUCR B
Pfizer
Pfizer-BioNTech COVID-19 Vaccine Pre-Diluted (Gray Cap) Administration - Booster
01/03/2022-04/18/2023
91306*
SARSCOV2 VAC 50MCG/0.25ML IM
Moderna
Moderna COVID-19 Vaccine (Aged 18 years and older) (Red Cap) (Low Dose)
10/20/2021-04/18/2023
0064A
ADM SARSCOV2 50MCG/0.25MLBST
Moderna
Moderna COVID-19 Vaccine (Red Cap) (Low Dose) Administration - Booster
10/20/2021-04/18/2023
91307*
SARSCOV2 VAC 10 MCG TRS-SUCR
Pfizer
Pfizer-BioNTech COVID-19 Pediatric Vaccine (Aged 5 years through 11 years) (Orange Cap)
10/29/2021-04/18/2023
0071A
ADM SARSCV2 10MCG TRS-SUCR 1
Pfizer
Pfizer-BioNTech COVID-19 Pediatric Vaccine (Orange Cap) - Administration - First dose
10/29/2021-04/18/2023
0072A
ADM SARSCV2 10MCG TRS-SUCR 2
Pfizer
Pfizer-BioNTech Covid-19 Pediatric Vaccine (Orange Cap) - Administration - Second dose
10/29/2021-04/18/2023
0073A
ADM SARSCV2 10MCG TRS-SUCR 3
Pfizer
Pfizer-BioNTech COVID-19 Pediatric Vaccine (Orange Cap) - Administration - Third dose
01/03/2022-04/18/2023
0074A
ADM SARSCV2 10MCG TRS-SUCR B
Pfizer
Pfizer-BioNTech COVID-19 Pediatric Vaccine (Orange Cap) - Administration - Booster
05/17/2022-04/18/2023
91308*
SARSCOV2 VAC 3MCG TRS-SUCR
Pfizer
Pfizer-BioNTech COVID-19 Pediatric Vaccine (Aged 6 months through 4 years) (Maroon Cap)
06/17/2022-04/18/2023
0081A
ADM SARSCOV2 3MCG TRS-SUCR 1
Pfizer
Pfizer-BioNTech COVID-19 Pediatric Vaccine (Aged 6 months through 4 years) (Maroon Cap) - Administration - First dose
06/17/2022-04/18/2023
0082A
ADM SARSCOV2 3MCG TRS-SUCR 2
Pfizer
Pfizer-BioNTech COVID-19 Pediatric Vaccine (Aged 6 months through 4 years) (Maroon Cap) - Administration - Second dose
06/17/2022-04/18/2023
0083A
ADM SARSCOV2 3MCG TRS-SUCR 3
Pfizer
Pfizer-BioNTech COVID-19 Pediatric Vaccine (Aged 6 months through 4 years) (Maroon Cap) - Administration - Third dose
06/17/2022-04/18/2023
91309*
SARSCOV2 VAC 50MCG/0.5ML IM
Moderna
Moderna COVID-19 Vaccine (Aged 6 years through 11 years or aged 18 years and older) (Blue Cap with purple border) 50MCG/0.5ML
03/29/2022-04/18/2023
0091A
ADM SARSCOV2 50 MCG/.5 ML1ST
Moderna
Moderna COVID-19 Pediatric Vaccine (Aged 6 years through 11 years) (Blue Cap with purple border) - Administration - First dose
06/17/2022-04/18/2023
0092A
ADM SARSCOV2 50 MCG/.5 ML2ND
Moderna
Moderna COVID-19 Pediatric Vaccine (Aged 6 years through 11 years) (Blue Cap with purple border) - Administration - Second dose
06/17/2022-04/18/2023
0093A
ADM SARSCOV2 50 MCG/.5 ML3RD
Moderna
Moderna COVID-19 Pediatric Vaccine (Aged 6 years through 11 years) (Blue Cap with purple border) - Administration - Third dose
06/17/2022-04/18/2023
0094A
ADM SARSCOV2 50MCG/0.5 MLBST
Moderna
Moderna COVID-19 Vaccine (Aged 18 years and older) (Blue Cap with purple border) 50MCG/0.5ML Administration - Booster
03/29/2022-04/18/2023
91311*
SARSCOV2 VAC 25MCG/0.25ML IM
Moderna
Moderna COVID-19 Pediatric Vaccine (Aged 6 months through 5 years) (Blue Cap with magenta border) 250MCG/0.25ML
06/17/2022-04/18/2023
0111A
ADM SARSCOV2 25MCG/0.25ML1ST
Moderna
Moderna COVID-19 Pediatric Vaccine (Aged 6 months through 5 years) (Blue Cap with magenta border) - Administration - First dose
06/17/2022-04/18/2023
0112A
ADM SARSCOV2 25MCG/0.25ML2ND
Moderna
Moderna COVID-19 Pediatric Vaccine (Aged 6 months through 5 years) (Blue Cap with magenta border) - Administration - Second dose
06/17/2022-04/18/2023
0121A
ADM SARSCV2 BVL 30MCG/.3ML 1
Pfizer
1st dose Pfizer Pfizer-BioNTech COVID-19 Vaccine, Bivalent (Age 12 years and older). Single dose.
04/18/2023-09/12/2023
0141A
ADM SRSCV2 BVL 25MCG/.25ML 1
Moderna
1st dose Moderna COVID-19 Vaccine, Bivalent (Age 6 months to 11 years old). First dose.
04/18/2023-09/12/2023
0142A
ADM SRSCV2 BVL 25MCG/.25ML 2
Moderna
2nd dose Moderna COVID-19 Vaccine, Bivalent (Age 6 months to 11 years old). Single dose.
04/18/2023-09/12/2023
0151A
ADM SARSCV2 BVL 10MCG/.2ML 1
Pfizer
1st dose Pfizer Pfizer-BioNTech COVID-19 Vaccine, Bivalent (Age 5 years through 11 years old). Single dose.
04/18/2023-09/12/2023
0171A
ADM SARSCV2 BVL 3MCG/0.2ML 1
Pfizer
1st dose Pfizer Pfizer-BioNTech COVID-19 Vaccine, Bivalent (Age 6 months through 4 years old). First dose.
04/18/2023-09/12/2023
0172A
ADM SARSCV2 BVL 3MCG/0.2ML 2
Pfizer
2nd dose Pfizer Pfizer-BioNTech COVID-19 Vaccine, Bivalent (Age 6 months through 4 years old)
04/18/2023-09/12/2023
91312
SARSCOV2 VAC BVL 30MCG/0.3M
Pfizer
Pfizer-BioNTech COVID-19 Vaccine, Bivalent Product (Aged 12 years and older) (Gray Cap)
08/31/2022-09/12/2023
0124A
ADM SARSCV2 BVL 30MCG/.3ML B
Pfizer
Pfizer-BioNTech COVID-19 Vaccine, Bivalent (Gray Cap) Administration – Additional dose
08/31/2022-09/12/2023
91313
SARSCOV2 VAC BVL 50MCG/0.5ML
Moderna
Moderna COVID-19 Vaccine, Bivalent Product (Aged 18 years and older) (Dark Blue Cap with gray border). Additional dose.
08/31/2022-09/12/2023
0134A
ADM SARSCV2 BVL 50MCG/.5ML B
Moderna
Moderna COVID-19 Vaccine, Bivalent (Aged 18 years and older) (Dark Blue Cap with gray border) Administration – Additional Dose
08/31/2022-09/12/2023
0113A
ADM SARSCOV2 25MCG/0.25ML3RD
Moderna
Moderna COVID-19 Pediatric Vaccine (Aged 6 months through 5 years) (Blue Cap with magenta border) - Administration - Third dose
06/17/2022
91314
SARSCOV2 VAC BVL 25MCG/.25ML
Moderna
Moderna COVID-19 Vaccine, Bivalent product (Age 6 months through 11 years). Additional dose.
10/12/2022-09/12/2023
0144A
COVID-19 Vaccine, Bivalent - Administration
Moderna
Moderna COVID-19 Vaccine, Bivalent - Administration – Additional Dose
10/12/2022-09/12/2023
91315
SARSCOV2 VAC BVL 10MCG/0.2ML
Pfizer
Pfizer-BioNTech COVID-19 Vaccine, Bivalent product
10/12/2022-09/12/2023
0154A
COVID-19 Vaccine, Bivalent - Administration
Pfizer
Pfizer COVID-19 Vaccine, Bivalent - Administration – Additional dose
10/12/2022-09/12/2023
91316
SARSCOV2 VAC BVL 10MCG/0.2ML
Moderna
Moderna COVID-19 Vaccine, Bivalent for use as a booster for ages 6 months through 5 years. Additional dose.
12/08/2022-09/12/2023
0164A
COVID-19 Vaccine, Bivalent Administration
Moderna
Moderna COVID-19 Vaccine, Bivalent Administration for use as a booster for ages 6 months through 5 years. Additional dose.
12/08/2022-09/12/2023
91317
SARSCOV2 VAC BVL 3MCG/0.2ML
Pfizer
Pfizer-BioNTech COVID-19 Vaccine, Bivalent for use as a third primary series dose for ages 6 months through 4 years
12/08/2022-09/12/2023
0172A
ADM SARSCV2 BVL 3MCG/0.2ML 2
Pfizer
Pfizer-BioNTech COVID-19 Vaccine, Bivalent for individuals 6 months through 4 years old. Second dose.
04/18/2023-09/12/2023
0173A
COVID-19 Vaccine, Bivalent Administration
Pfizer
Pfizer-BioNTech COVID-19 Vaccine, Bivalent
12/08/2022-09/12/2023
0174A
Pfizer-BioNtech COVID-19 Vaccine, Bivalent – Booster Dose
Pfizer
Pfizer-BioNTech COVID-19 Vaccine, Bivalent administration for use as a third primary series dose for ages 6 months through 4 years. Additional dose.
03/14/2023-09/12/2023
90480
ADMN SARSCOV2 VACC 1 DOSE
N/A
Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, single dose
09/11/2023
M0201**
COVID-19 vaccine home admin
N/A
COVID-19 vaccine administration inside a patient’s home; reported only once per individual home per date of service when only COVID-19 vaccine administration is performed at the patient’s home
06/08/2021
Q0224
Inj, pemivibart, 4500 mg
N/A
Injection, pemivibart, for the pre-exposure prophylaxis only, for certain adults and adolescents (12 years of age and older weighing at least 40 kg) with no known SARS-CoV-2 exposure, and who either have moderate-to-severe immune compromise due to a medical condition or receipt of immunosuppressive medications or treatments, and are unlikely to mount an adequate immune response to COVID-19 vaccination, 4500 mg
03/22/2024
M0224
Pemivibart infusion
N/A
Intravenous infusion, pemivibart, for the pre-exposure prophylaxis only, for certain adults and adolescents (12 years of age and older weighing at least 40 kg) with no known SARS-CoV-2 exposure, who either have moderate-to-severe immune compromise due to a medical condition or receipt of immunosuppressive medications or treatments, includes infusion and post administration monitoring
03/22/2024
*Providers should not bill for the product if they received it for free.
**Only allowed on claims with TOB 13X, 34X, 72X, 75X, 81X, 82X, and 85X. For additional billing information on M0201, review CMS’ infographic on Medicare payment for COVID-19 vaccine administration in the home external pdf file.
***For information on dosing intervals, refer to the CDC article U.S. COVID-19 Vaccine Product Information external link.
Billing example for first dose:
Billing example of first dose for COVID-19 administration
Billing example for second dose:
Billing example for second dose of COVID-19 administration
Condition Code:
A6 - 100% payment
78 - New coverage not implemented by Medicare Advantage (Billed on claims for Medicare Advantage beneficiaries only).
example of reporting condition code A6
Diagnosis code:
Z23 - Encounter for immunization
 example of diagnosis code reporting of z23
Note: For vaccines provided for inpatients, use the date of discharge or date Part A benefits exhausted as the date of service.

Monoclonal antibodies and administration

Revenue codes:
0771 -- preventive care services, vaccine administration
0636 -- pharmacy, drugs requiring detailed coding
Monoclonal antibodies and administration codes:

Code
Description
Labeler name
Vaccine/procedure name
Effective date
Q0220*
Tixagev and cilgav, 300mg
AstraZeneca
Injection, tixagevimab and cilgavimab, for the pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available COVID-19 vaccine is not recommended due to a history of severe adverse reaction to a COVID-19 vaccine(s) and/or COVID-19 vaccine component(s), 300 mg
12/08/2021 – 01/26/2023
Q0221*
Tixagev and cilgav, 600mg
AstraZeneca
Injection, tixagevimab and cilgavimab, for the pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available COVID-19 vaccine is not recommended due to a history of severe adverse reaction to a COVID-19 vaccine(s) and/or COVID-19 vaccine component(s), 600 mg
02/24/2022 – 01/26/2023
M0220
Tixagev and cilgav inj
AstraZeneca
Injection, tixagevimab and cilgavimab, for the pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available COVID-19 vaccine is not recommended due to a history of severe adverse reaction to a COVID-19 vaccine(s) and/or COVID-19 vaccine component(s), includes injection and post administration monitoring
12/08/2021 – 01/26/2023
M0221
Tixagev and cilgav inj hm
AstraZeneca
Injection, tixagevimab and cilgavimab, for the pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available COVID-19 vaccine is not recommended due to a history of severe adverse reaction to a COVID-19 vaccine(s) and/or COVID-19 vaccine component(s), includes injection and post administration monitoring in the home or residence; this includes a beneficiary’s home that has been made provider-based to the hospital during the COVID-19 public health emergency
12/08/2021 – 01/26/2023
Q0222****
Bebtelovimab 175 mg
Eli Lilly
Injection, bebtelovimab, 175 mg
02/11/2022 – 11/30/2022
M0222
Bebtelovimab injection
Eli Lilly
Intravenous injection, bebtelovimab, includes injection and post administration monitoring
02/11/2022 – 11/30/2022
M0223
Bebtelovimab injection home
Eli Lilly
Intravenous injection, bebtelovimab, includes injection and post administration monitoring in the home or residence; this includes a beneficiary’s home that has been made provider-based to the hospital during the COVID-19 public health emergency
02/11/2022 – 11/30/2022
Q0239*
bamlanivimab-xxxx
Eli Lilly
Injection, bamlanivimab, 700 mg
11/10/2020 – 04/16/2021
M0239
bamlanivimab-xxxx infusion
Eli Lilly
Intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoring
11/10/2020 – 04/16/2021
Q0240*
Casirivi and imdevi 600mg
Regeneron
Injection, casirivimab and imdevimab, 600 mg
07/30/2021 – 01/24/2022
M0240
Casiri and imdev repeat
Regeneron
Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring, subsequent repeat doses
07/30/2021 – 01/24/2022
M0241
Casiri and imdev repeat hm
Regeneron
Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring in the home or residence, this includes a beneficiary's home that has been made provider-based to the hospital during the COVID-19 public health emergency, subsequent repeat doses
07/30/2021 – 01/24/2022
Q0243*
casirivimab and imdevimab
Regeneron
Injection, casirivimab and imdevimab, 2400 mg
11/21/2020 – 01/24/2022
M0243
Casirivi and imdevi inj
Regeneron
Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring
11/21/2020 – 01/24/2022
Q0244**
casirivi and imdevi 1200 mg
Regeneron
Injection, casirivimab and imdevimab, 1200 mg
06/03/2021 – 01/24/2022
M0244**
Casirivi and imdevi inj hm
Regeneron
Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring in the home or residence; this includes a beneficiary’s home that has been made provider-based to the hospital during the COVID-19 public health emergency
05/06/2021 – 01/24/2022
Q0245*
bamlanivimab and etesevima
Eli Lilly
Injection, bamlanivimab and etesevimab, 2100 mg
02/09/2021 – 01/24/2022
M0245
bamlan and etesev infusion
Eli Lilly
Intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring
02/09/2021 – 01/24/2022
M0246**
bamlan and etesev infus home
Eli Lilly
Intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring in the home or residence; this includes a beneficiary’s home that has been made provider-based to the hospital during the COVID-19 public health emergency
05/06/2021 – 01/24/2022
Q0247***
sotrovimab
GSK
Injection, sotrovimab, 500 mg
05/26/2021 – 04/05/2022
M0247
sotrovimab infusion
GSK
Intravenous infusion, sotrovimab, includes infusion and post administration monitoring
05/26/2021 – 04/05/2022
M0248**
sotrovimab inf, home admin
GSK
Intravenous infusion, sotrovimab, includes infusion and post administration monitoring in the home or residence; this includes a beneficiary’s home that has been made provider-based to the hospital during the COVID-19 public health emergency
05/26/2021 – 04/05/2022
Q0249***
Tocilizumab for COVID-19
Genentech
Injection, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older) with COVID-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) only, 1 mg
06/24/2021
M0249
Adm Tocilizu COVID-19 1st
Genentech
Intravenous infusion, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older) with COVID-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) only, includes infusion and post administration monitoring, first dose
06/24/2021
M0250
Adm Tocilizu COVID-19 2nd
Genentech
Intravenous infusion, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older) with COVID-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) only, includes infusion and post administration monitoring, second dose
06/24/2021
*Providers should not bill for the product if they received it for free.
**Only allowed on claims with TOB 13X, 22X, 23X, 34X, 72X, 75X, 81X, 82X, and 85X
***The government won’t provide this drug for free.
****Q0222 – Eli Lilly started commercial distribution on August 15. For dates of service on or after August 15, claims for commercially acquired treatments may be allowed at the new payment rate of $2,394.00. You may have supplies of both the United States Government (USG)-procured and commercially procured product. Providers should only bill above a nominal amount for the commercially procured product. You can identify the commercially procured vials by the batch number D534422 and other batch numbers will be issued. Review the batch number prior to claim submission to determine if the product was USG procured or commercially procured and ensure appropriate billing.
Note: If you received RTP reason code 32287 on inpatient claims (TOB 12X) for HCPCS code Q0249 due to being billed with more than one unit or the HCPCS code M0201 due to another administration code on the same claim, F9 the claim for reprocessing.
Billing example for infusion:
  Billing example for infusion
Condition Code:
78 - New coverage not implemented by Medicare Advantage (Billed on claims for Medicare Advantage beneficiaries only).
Diagnosis codes:
Use appropriate diagnosis coded to highest level of specificity
U071 – use as appropriate
Note: For vaccines provided for inpatients, use the date of discharge or date Part A benefits exhausted as the date of service.

Rural health clinics and federally qualified health centers

Independent and provider-based rural health clinics (RHCs) and federally qualified health centers (FQHCs) do not include charges for the COVID-19 vaccine and monoclonal antibodies on a claim form.
Administration of these vaccines does not count as a visit when the only service involved is the administration of the COVID-19 vaccine and/or monoclonal antibodies.
If there was another reason for the visit, the RHC/FQHC should bill for the visit without adding the cost of the COVID-19 vaccine and/or monoclonal antibodies to the charge for the visit on the bill.
Payment is made at the time of cost settlement.

SNFs – Enforcement discretion to certain pharmacy billing

To facilitate the efficient administration of COVID-19 vaccines and monoclonal antibody treatments to SNF residents, CMS will exercise enforcement discretion with respect to these statutory provisions as well as any associated statutory references and implementing regulations, including as interpreted in pertinent guidance, SNF CB Provisions. Through the exercise of that discretion, CMS will allow Medicare-enrolled immunizers, including but not limited to pharmacies working with the United States, to bill directly and receive direct reimbursement from the Medicare program for vaccinating Medicare SNF residents.
The enforcement discretion associated with vaccinating Medicare SNF residents ended on June 30, 2023, meaning that immunizers are no longer be able to bill Medicare directly for vaccines furnished to patients for a Medicare Part A-covered SNF stay. Beginning on July 1 ,2023, typical SNF consolidated billing regulations are in place, which require SNFs to bill for all services furnished to patients in a Medicare-covered SNF stay, including vaccines.

References

FDA: COVID-19 Vaccines external link webpage
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.