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Last Modified: 8/26/2021 Location: FL, PR, USVI Business: Part B

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

This article will assist Medicare Part B providers with proper billing relating to Coronavirus (COVID-19) vaccine and monoclonal antibody 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 refer to 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.

COVID-19 vaccines and administration

Code
Description
Labeler name
Vaccine/procedure name
Effective date
Dosing interval
91300*
SARSCOV2 VAC 30MCG/0.3ML IM
Pfizer
Pfizer-Biontech COVID-19 Vaccine
12/11/2020
21 days
0001A
ADM SARSCOV2 30MCG/0.3ML 1ST
Pfizer
Pfizer-Biontech COVID-19 Vaccine Administration – First Dose
12/11/2020
21 days
0002A
ADM SARSCOV2 30MCG/0.3ML 2ND
Pfizer
Pfizer-Biontech COVID-19 Vaccine Administration – Second Dose
12/11/2020
21 days
0003A
ADM SARSCOV2 30MCG/0.3ML 3RD
Pfizer
Pfizer-Biontech COVID-19 Vaccine Administration – Third Dose
08/12/2021
28 days
91301*
SARSCOV2 VAC 100MCG/0.5ML IM
Moderna
Moderna COVID-19 Vaccine
12/18/2020
28 days
0011A
ADM SARSCOV2 100MCG/0.5ML1ST
Moderna
Moderna COVID-19 Vaccine Administration – First Dose
12/18/2020
28 days
0012A
ADM SARSCOV2 100MCG/0.5ML2ND
Moderna
Moderna COVID-19 Vaccine Administration – Second Dose
12/18/2020
28 days
0013A
ADM SARSCOV2 100MCG/0.5ML3RD
Moderna
Moderna COVID-19 Vaccine Administration – Third Dose
08/12/2021
28 days
91302*
SARSCOV2 VAC 5X10^10VP/.5MLIM
AstraZeneca
AstraZeneca COVID-19 Vaccine
TBD
28 days
0021A
ADM SARSCOV2 5X10^10VP/.5ML 1
AstraZeneca
AstraZeneca COVID-19 Vaccine Administration – First Dose
TBD
28 days
0022A
ADM SARSCOV2 5X10^10VP/.5ML 2
AstraZeneca
AstraZeneca COVID-19 Vaccine Administration – Second Dose
TBD
28 days
91303*
SARSCOV2 VAC AD26 .5ML IM
Janssen
Janssen COVID-19 Vaccine
02/27/2021
N/A
0031A
ADM SARSCOV2 VAC AD26 .5ML
Janssen
Janssen COVID-19 Vaccine Administration
02/27/2021
N/A
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
6/8/2021
N/A
*Providers should not bill for the product if they received it for free.
**Billable only in places of service 04, 06, 09, 12, 13, 14, 16, 19, 22, 33, 54, 55, 56, and 60. For additional billing information on M0201, review CMS’ infographic on Medicare payment for COVID-19 vaccine administration in the home external pdf file.
Providers can submit claims using the following claim example:
Claim should include the proper billing of the ICD-10 in item 21:
Z23 - Encounter for immunization
Report the proper date of service
Report the proper place of service
Use the applicable CPT or HCPCs code
The diagnosis pointer should be used to indicate the primary diagnosis on the claim form

Monoclonal antibodies and administration

Code
Description
Labeler name
Vaccine/procedure name
Effective date
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
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
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
Q0243*
casirivimab and imdevimab
Regeneron
Injection, casirivimab and imdevimab, 2400 mg
11/21/2020
M0243
Casirivi and imdevi inj
Regeneron
Intravenous infusion or subcuteaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring
11/21/2020
Q0244*
casirivi and imdevi 1200 mg
Regeneron
Injection, casirivimab and imdevimab, 1200 mg
06/03/2021
M0244
Casirivi and imdevi inj hm
Regeneron
Intravenous infusion or subcuteaneous 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
Q0245*
bamlanivimab and etesevima
Eli Lilly
Injection, bamlanivimab and etesevimab, 2100 mg
02/09/2021
M0245
bamlan and etesev infusion
Eli Lilly
intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring
02/09/2021
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
Q0247**
sotrovimab
GSK
Injection, sotrovimab, 500 mg
05/26/2021
M0247
sotrovimab infusion
GSK
Intravenous infusion, sotrovimab, includes infusion and post administration monitoring
05/26/2021
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
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.
**The government won’t provide this drug for free.
Providers can submit claims using the following claim example:
Claim should include the proper billing of the ICD-10 in item 21:
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 applicable 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
Click here for information on billing these services through roster billing.

References

CDC: COVID-19 Vaccination Communication Toolkit external link for medical centers, clinics, and clinicians
FDA: COVID-19 Vaccines external link webpage
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