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PROVIDER BILLING GUIDANCE FOR COVID-19 TESTING

THE CENTERS FOR MEDICARE AND MEDICAID (CMS) RELEASE BILLING GUIDELINES FOR COVID-19 Vaccine

Arkansas Total Care is following advancements in the prevention and treatment of COVID-19, including vaccinations. As a healthcare provider, you will play an integral role as COVID-19 vaccines become available. We want to update you on important new information about vaccine coverage.

To prepare for vaccine administration, the Centers for Medicare and Medicaid (CMS) have published billing guidance (PDF) for Medicaid and Children’s Health Insurance Program (CHIP) providers. Same as other COVID-19 services, the vaccines will be available at no cost to your patients. Also:

  • Arkansas Total Care will configure its systems to properly adjudicate COVID-19 vaccine-related claims, both for the vaccine and its administration, in accordance with Arkansas’s coverage determinations for Medicaid beneficiaries
  • Member liability will be $0
  • No Non-participating provider pre-auth requirements is needed
  • Provider reimbursement rates and emergency use authorizations (EUA) are all still pending. We will update you as that information becomes available

The American Medical Association (AMA) has published updates to the Current Procedural Terminology (CPT®) code set that includes new vaccine-specific codes. These codes report immunizations for the novel coronavirus (SARS-CoV-2). We will continue to be updated the code set. More vaccines will receive EUA approval by the U.S. Food & Drug Administration (FDA).

The following codes are available on November 10, 2020. The codes will not be effective until the vaccine receives official EUA approval.

Code

CPT Short Descriptor

Labeler Name

Vaccine/Procedure Name

91300

SARSCOV2 VAC

30MCG/0.3ML IM

Pfizer

Pfizer-Biotech Covid-19 Vaccine

0001A

ADM SARSCOV2 VAC

30MCG/0.3ML 1ST

Pfizer

Pfizer-Biotech Covid-19 Vaccine

Administration – First Dose

0002A

ADM SARSCOV2 VAC

30MCG/0.3ML 2ND

Pfizer

Pfizer-Biotech Covid-19 Vaccine

Administration – Second Dose

91301

SARSCOV2 VAC

100MCG/0.5ML IM

Moderna

Moderna Covid-19 Vaccine

0011A

ADM SARSCOV2 VAC

100MCG/0.5ML 1ST

Moderna

Moderna Covid-19 Vaccine

Administration – First Dose

0012A

ADM SARSCOV2 VAC

100MCG/0.5ML 2ND

Moderna

Moderna Covid-19 Vaccine

Administration – Second Dose

CMS has also published a set of toolkits to help providers prepare to administer the vaccine. You may have further questions about the upcoming vaccine or the COVID-19 services. Please contact Provider Services at 1-866-282-6280 or TTY: 711.

Last updated: 12.4.2020