Coding Updates – 2021
The continued development of COVID-19 treatments and vaccines has prompted updates in CPT coding and billing guidelines. In addition to the updated E&M code requirements, the American Medical Association developed COVID-19 codes for each of the four coronavirus vaccines and their administrations.
- 91300: this is for the Pfizer vaccine only.
- For the first administered shot, use CPT code 0001A and for the second shot administered, use 0002A.
- The NDC number for this vaccine is: 59267-1000-1.
- The doses should be given 21 days apart.
- 91301: this is for the Moderna vaccine only.
- For the first administered shot, use CPT code 0011A and for the second administered shot, use 0012A.
- The NDC number for this vaccine is: 80777-0273-10.
- The doses should be given 28 days apart.
- 91302: this is for the AstraZeneca vaccine only.
- For the first administered shot, use CPT code 0021A and for the second shot administered, use 0022A.
- The NDC number for this vaccine is: 00310-1222-10. The doses should be given 28 days apart.
- 91303: this is for Janssen vaccine only.
- This is the first single dose vaccine and the CPT code for administering the vaccine is 0031A.
- The NDC number for this vaccine is: 59676-0580-05.
These codes will be adopted and paid for by The Centers for Medicare and Medicaid Services. CMS made several other changes, including a rare fee schedule increase for COVID-19 related services. The December 28, 2020 signing of a new COVID-19 relief bill allowed an increase of 3.75 percent. However, CMS will be maintaining payment rates for immunization administration services described by CPT codes 90460, 90461, 90471, 90472, 90473, and 90474 and HCPCS codes G0008, G0009, and G0010. It is expected that for 2022, the increase will expire and return to the old fee schedule rates. Additional updates and changes include:
- The Medicare Payments Sequestration Deduction has been extended to March 31, 2021.
- This deduction began in 2012 and was originally due to end on December 31, 2020.
- The Medicare Sequestration is a two percent deduction from Medicare payments to account for the debt ceiling increase offset.
- There are new categories for Telehealth services for 2021.
- Category 1: codes that are permanently added as covered under Medicare but are similar to other services
- Category 2: codes that are permanently added as covered under Medicare but are not similar to other services.
- Category 3: codes that are temporarily covered under the Medicare through the end of the year in which the public health emergency for COVID-19 ends. CMS will then evaluate whether they should become Category 1 or Category 2 codes.
In order to be considered for coverage, CMS requires clinical studies demonstrating the service furnished via telehealth improves the patient’s diagnosis or treatment of an illness or injury.
- At the end of the public health emergency (currently scheduled to end April 20, 2021), there will be no separate payment for the audio-only CPT codes. A mew CPT code will be created
- G2252: an 11 – 20 minute audio-only visit
This is to be used when the severity of the patient’s problem is not likely to warrant an in-person visit. It will be for established patients only and the same seven-day/next 24-hour rule applies.
The CMS Guidelines for Reporting & Coding can be found here: CMS Official Guidelines
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