Audience: Physicians, Nurse Midwives, Hospitals and Facilities
To ensure that you are ready to order, receive and administer the COVID-19 vaccine as it becomes available, please refer to the New York State Department of Health (NYS DOH) website and the Governor’s news page for information and resources critical to enrolling in the COVID-19 Vaccination Program, the vaccine distribution plan and how to order, receive and administer the vaccine.
The Center for Medicare & Medicaid Services (CMS) website provides information related to vaccine reporting requirements and other resources that will be critical to your practice or facility as you prepare to vaccinate against COVID-19.
Member Cost-Share Responsibility; Reimbursement Information
The initial supply of COVID-19 vaccines will be provided free of charge by the federal government; Excellus BCBS will provide reimbursement for the administration of the vaccine only. This may change when the public health emergency is lifted; we will communicate any changes as they become available from the federal government.
Provisions of the CARES Act require COVID-19 vaccines to be administered with no member-cost share (covered in full) regardless of an individual’s health insurance benefits or coverage.
For the Safety Net line of business/products (HMOBlue Option, Blue Choice Option, Premier Option, Blue Option Plus, Premier Option Plus, Child Health Plus and Premier Child Health Plus, Healthy NY and the Essential Plan) Excellus BCBS will mirror New York State Medicaid rates for vaccine administration.
If NYS Medicaid has not issued a rate for a covered service, Excellus BCBS will use the reimbursement rate used by CMS until a rate is issued by NYS DOH. If NYS DOH subsequently issues a lower rate or determines that a service is not covered or is separately reimbursable, we will auto-adjust any impacted claims.
For all other products and lines of business, Excellus BCBS will mirror Medicare reimbursement rates established by CMS.
The following CPT® codes must be used when billing COVID-19 vaccine administration:
|0001A:||Pfizer Biontech COVID-19 Vaccine Administration First Dose||$16.94|
|0002A:||Pfizer Biontech COVID-19 Vaccine Administration Second Dose||$28.39|
|0011A:||Moderna COVID-19 Vaccine Administration First Dose||$16.94|
|0012A:||Moderna COVID-19 Vaccine Administration Second Dose||$28.39|
|0021A:||AstraZeneca COVID-19 Vaccine Administration First Dose **|
|0022A:||AstraZeneca COVID-19 Vaccine Administration Second Dose **|
We encourage you to review CMS’ COVID-19 Frequently Asked Questions on Medicare Fee-for-Service (FFS) BillingOpen a PDF for additional information.
Please refer to the Excellus BCBS Administrative Policy 15 - Evaluation & Management and Vaccine Administration, for additional information related to COVID-19 vaccine administration. This policy will be reviewed pre-payment and post-payment. Pre-payment review means that claims are reviewed prior to payment. A pre-payment review results in an initial determination. Post-payment review means that claims are reviewed after adjudication. A post-payment review may result in either no change to the initial determination or a revised determination.
These services are subject to audit and policy updates at the discretion of Excellus BCBS.
*A “grandfathered” plan is an individual health insurance policy purchased on or before March 23, 2010. As such, these plans may not include some rights and protections provided under the Affordable Care Act.
**For use following the FDA’s issuance of an emergency use authorization.