COVID-19 Updates – Part 2
THE AMA ADDS CPT CODE FOR THIRD COVID-19 VACCINATION
In mid-August, the American Medical Association announced the code set for the third doses of the Pfizer and Moderna COVID-19 vaccines. Below are the codes for both the Pfizer-BioTech & the Moderna vaccines:
- 91300: this is for the Pfizer vaccine only.
- For the first shot, use code 0001A
- For the second shot, use 0002A
- For the third shot, use 0003A
- The NDC number for this vaccine is: 59267-1000-1
- 91301: this is for the Moderna vaccine only.
- For the first shot, use 0011A
- For the second shot, use 0012A
- For the third shot, use 0013A
- The NDC number for this vaccine is: 80777-0273-10
The full article can be read here: https://www.ama-assn.org/press-center/press-releases/ama-announces-cpt-code-set-ready-third-doses-covid-19-vaccines
WHO IS COVERED?
On August 12, 2021, the Food and Drug Administration (FDA) recommended that immunocompromised individuals get a COVID-19 booster shot. The next day, the Centers for Medicaid and Medicare services announced that they will cover the third COVID-19 shot at no cost to the member.
The CDC considers those with the following conditions to be eligible:
- Patients actively receiving cancer treatment(s) for a tumor or cancer of the blood.
- Patients who have received an organ transplant and are taking medicine to suppress the immune system
- Received a stem cell transplant within the last 2 years or are taking medications used to suppress the immune system.
- Patients with a moderate or severe primary immunodeficiency. Examples: DiGeorge syndrome and Wiskott-Aldrich syndrome.
- Patients who have advances or untreated HIV infection
- Patients who are actively being treated with high-dose corticosteroids or other drugs that may suppress your immune response.
Additional coverage information can be found here:https://healthpayerintelligence.com/news/medicare-covers-covid-19-booster-for-immunocompromised-americans?eid=CXTEL000000597475&elqCampaignId=20844&utm_source=nl&utm_medium=email&utm_campaign=newsletter&elqTrackId=932f3a585b45429b83949c01375af043&elq=de4debd1ee054fe4b2f77e006811be0b&elqaid=21702&elqat=1&elqCampaignId=20844
Or here: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations/immuno.html#:~:text=•%20Been%20receiving%20active%20cancer,may%20suppress%20your%20immune%20response
MEDICARE REIMBURSEMENT CHANGES
Back in March, the Centers for Medicare and Medicaid Services released the reimbursement amounts for the COVID-19 vaccines:
- $0.010 per unit
- First Administration
- Second Administration
However, rates have changed and CMS is paying more on the administration fees. The vaccine reimbursement will remain the same but all administration fees will have an allowed amount of $40.00. For a detailed chart of reimbursements, including the billing codes, visit the CMS.gov website or click here: https://www.cms.gov/medicare/medicare-part-b-drug-average-sales-price/covid-19-vaccines-and-monoclonal-antibodies
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