Are You Billing Correctly for the New COVID-19 Vaccine? Here are 9 Ways to Ensure Proper Payment

The COVID-19 pandemic has led to a rapid change of billing requirements and the development of new codes, making an already tough job for revenue cycle teams that much harder.

To help, we’ve outlined nine coding/billing rules below that top-performing medical groups are using to ensure complete payment when administering the COVID-19 vaccine. Please note, these rules are not one size fits all; they often require customization to meet unique payer requirements.

1. When billing for COVID-19 Vaccine 91300 (Pfizer), adding either the first dose code: 0001A or second dose code: 0002A is required.
2. When billing for COVID-19 Vaccine 91301 (Moderna), adding either the first does code: 0011A or second dose code: 0012A is required.
3. When billing COVID-19 vaccine administration codes 0001A or 0002A, ensure the vaccine code 91300 is on the encounter.
4. When billing COVID-19 vaccine administration codes 0011A or 0012A, ensure the vaccine code 91301 is on the encounter.
5. If the second dose CPT code for the Pfizer COVID-19 vaccine: 0002A is listed, check the previous 21 days of charge history to see if the first dose CPT code: 0001A was noted to ensure the correct dose administration code is included.
6. If the second dose CPT code for the Moderna COVID-19 vaccine: 0012A is listed, check the previous 28 days of charge history to see if the first dose CPT code: 0011A was noted to ensure the correct dose administration code is included.
7. When the first dose Pfizer COVID-19 vaccine CPT code 0001A is listed check the previous 21 days of charge history to ensure that same code isn’t listed. If it is, review the encounter and change to the second dose code, 0002A.
8. When the first dose Monderna COVID-19 vaccine CPT code 0011A is listed check the previous 28 days of charge history to ensure that same code isn’t listed. If it is, review the encounter and change to the second dose code, 0012A.
9. When billing for the COVID-19 vaccine and administration the ICD-10 code, Z23, must be linked to the charge line. 

To help ensure complete and accurate payment for all COVID-19 related services, check out these five high value coding and billing rules for diagnosis and testing.

COVID-19 updates aside, keeping track of payer requirements is challenging. Our Revenue Cycle Rules product allows a revenue cycle team member to create custom rules based on their organization’s unique needs and payer requirements.

To learn more about how our rules engine can help you, schedule a 1:1 meeting.

For more detailed information on the first set of COVID-19 vaccine and administration codes. See the CPT Assistant Coding Guide.