COVID-19 Vaccine Administration: A Guide to Reimbursement and Coding

Health care providers who are authorized to administer the coronavirus are contributing in a big way to the health of their community.  As COVID-19 vaccines are currently supplied by the federal government, though, there are strict rules about reimbursement and coding for vaccine administration. The Centers for Medicare and Medicaid Services (CMS) has established the following guidelines:

• Participating providers must agree to administer a COVID-19 vaccine regardless of an individual’s ability to pay or their coverage status, even if they have no insurance, and also may not seek any reimbursement, including through balance billing, from a vaccine recipient.
• Providers with questions about billing or reimbursement for vaccination of privately insured or Medicaid patients should contact the respective health plan or state Medicaid agency.
• When administering the COVID-19 vaccine to people without health insurance or whose insurance does not cover the vaccine, providers can request reimbursement through the Provider Relief Fund.

Sara DiBlasio, director of coding at Strategic Solutions, has developed the following chart as a guide for the company’s billing specialists and clients. It is imperative that the correct codes be utilized to aid tracking by the CDC and CMS. 

At Strategic Solutions, we routinely research and educate our staff and clients on new rules, processes, and procedures that impact billing and medical practice procedures, which is especially important during a pandemic. For more information about all the services offered by Strategic Solutions, please contact Karen Normington, business development specialist, by email or phone.