Important information: Submit all claims to original Medicare fee-for-service contractor, NOT the Medicare Advantage Plan.
National Government Services is the MAC for J6 - Illinois, Minnesota and Wisconsin, as well as JK - Connecticut, Maine, Massachusetts, New Hampshire, New York, Rhode Island and Vermont
If you use roster billing for institutional claims, you must administer shots to at least five patients on the same date, unless the institution is an inpatient hospital. You can also submit individual claims.
**For hospitalized patients, Medicare pays for the COVID-19 shots separately from the DRG rate and disallows billing them on 11X.
Electronic Claims
Use Direct Data Entry:
Paper Claims
If you use roster billing for professional claims, you must administer the same type of shot to five or more people on the same date of service. You can also submit individual claims.
Electronic Claims Options available:
Paper Claims
Streamlined process for submitting vaccination claims for large groups of individuals.
The patient roster form includes the following with a single modified CMS-1500 claim form as roster cover document for each facility where the services are rendered:
Centralized Billers: Centralized billing allows mass immunizers to send all roster bill claims for flu, pneumococcal, and soon to be added COVID-19 vaccinations to a single MAC, Novitas, for payment, regardless of where you administer the shots. Medicare makes geographic payment adjustments based on the locality where you administer the shot. You must submit all centralized biller claims as professional claims on a roster bill.You must operate in at least three MAC Jurisdictions. You can refer to the Who are the MACs web page on the CMS website.
CMS has released a set of toolkits for providers, states and insurers to help the health care system prepare and assist in swiftly administering these products once they become available. These toolkits are located on CMS' COVID-19 Vaccine Policies & Guidance web page. These resources are designed to increase the number of providers that can administer the products and ensure adequate reimbursement for administration in Medicare, while making it clear to private insurers and Medicaid programs their responsibility to cover these products at no charge to beneficiaries. This webpage provides the payment allowances and other related information for these products. For more information, review the COVID-19 provider toolkit.
Code | CPT Short Descriptor | Labeler Name | Vaccine/Procedure Name | Payment Allowance | Effective Dates |
---|---|---|---|---|---|
91300 |
SARSCOV2 VAC 30MCG/0.3ML IM |
Pfizer |
Pfizer-Biontech Covid-19 Vaccine |
$0.010* |
12/11/2020 – TBD |
0001A |
ADM SARSCOV2 30MCG/0.3ML 1ST |
Pfizer |
Pfizer-Biontech Covid-19 Vaccine Administration – First Dose |
$16.940** |
12/11/2020 – TBD |
0002A |
ADM SARSCOV2 30MCG/0.3ML 2ND |
Pfizer |
Pfizer-Biontech Covid-19 Vaccine Administration – Second Dose |
$28.390** |
12/11/2020 – TBD |
91301 |
SARSCOV2 VAC 100MCG/0.5ML IM |
Moderna |
Moderna Covid-19 Vaccine |
$0.010* |
12/18/2020 – TBD |
0011A |
ADM SARSCOV2 100MCG/0.5ML1ST |
Moderna |
Moderna Covid-19 Vaccine Administration – First Dose |
$16.940** |
12/18/2020 – TBD |
0012A |
ADM SARSCOV2 100MCG/0.5ML2ND |
Moderna |
Moderna Covid-19 Vaccine Administration – Second Dose |
$28.390** |
12/18/2020 – TBD |
91302 |
SARSCOV2 VAC 5X10^10VP.5MLIM |
AstraZeneca |
AstraZeneca Covid-19 Vaccine |
$0.010* |
xx/xx/xxxx – TBD |
0021A |
ADM SARSCOV2 5X10^10VP.5ML 1 |
AstraZeneca |
AstraZeneca Covid-19 Vaccine Administration – First Dose |
$16.940** |
xx/xx/xxxx – TBD |
0022A |
ADM SARSCOV2 5X10^10VP.5ML 2 |
AstraZeneca |
AstraZeneca Covid-19 Vaccine Administration – Second Dose |
$28.390** |
xx/xx/xxxx – TBD |
*Since we anticipate that providers, initially, will not incur a cost for the product, CMS will update the payment allowance at a later date. Providers should not bill for the product if they received it for free.
**These rates will also be geographically adjusted for many providers. For providers and suppliers with payments that are geographically adjusted by the methodology used by the Medicare Physician Fee Schedule, files with the geographically adjusted payment rates for COVID-19 vaccine administration are included in the “Additional Resources” section below. Certain settings utilize other payment methodologies, such as payment based on reasonable costs.
Code | CPT Short Descriptor | Labeler Name | Vaccine/Procedure Name | Payment Allowance | Effective Dates |
---|---|---|---|---|---|
Q0239 |
bamlanivimab-xxxx |
Eli Lilly |
Injection, bamlanivimab, 700 mg |
$0.010* |
11/10/2020 – TBD |
M0239
|
bamlanivimab-xxxx infusion |
Eli Lilly |
Intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoring |
$309.600*** |
11/10/2020 – TBD |
Q0243 |
casirivimab and imdevimab |
Regeneron |
Injection, casirivimab and imdevimab, 2400 mg |
$0.010* |
11/21/2020 – TBD |
M0243 |
casirivi and imdevi infusion |
Regeneron |
intravenous infusion, casirivimab and imdevimab includes infusion and post administration monitoring |
$309.600*** |
11/21/2020 – TBD |
*Since we anticipate that providers, initially, will not incur a cost for the product, CMS will update the payment allowance at a later date. Providers should not bill for the product if they received it for free.
*** Medicare will pay a rate of $309.60 for many providers. These rates will also be geographically adjusted for many providers. For providers and suppliers with payments that are geographically adjusted by the methodology used by the Medicare Physician Fee Schedule, files with the geographically adjusted payment rates for monoclonal antibody administration are included in the “Additional Resources” section below. Certain settings utilize other payment methodologies, such as payment based on reasonable costs.
Code | Description | Labeler name | Vaccine/procedure name | Effective date | Dosing interval |
---|---|---|---|---|---|
91300* |
SARSCOV2 VAC 30MCG/0.3ML IM |
Pfizer |
Pfizer-Biontech Covid-19 Vaccine |
12/11/2020 |
21 days |
0001A |
ADM SARSCOV2 30MCG/0.3ML 1ST |
Pfizer |
Pfizer-Biontech Covid-19 Vaccine Administration – First Dose |
12/11/2020 |
21 days |
0002A |
ADM SARSCOV2 30MCG/0.3ML 2ND |
Pfizer |
Pfizer-Biontech Covid-19 Vaccine Administration – Second Dose |
12/11/2020 |
21 days |
91301* |
SARSCOV2 VAC 100MCG/0.5ML IM |
Moderna |
Moderna Covid-19 Vaccine |
12/18/2020 |
28 days |
0011A |
ADM SARSCOV2 100MCG/0.5ML1ST |
Moderna |
Moderna Covid-19 Vaccine Administration – First Dose |
12/18/2020 |
28 days |
0012A |
ADM SARSCOV2 100MCG/0.5ML2ND |
Moderna |
Moderna Covid-19 Vaccine Administration – Second Dose |
12/18/2020 |
28 days |
91302* |
SARSCOV2 VAC 5X10^10VP.5MLIM |
AstraZeneca |
AstraZeneca Covid-19 Vaccine |
TBD |
28 days |
0021A |
ADM SARSCOV2 5X10^10VP.5ML 1 |
AstraZeneca |
AstraZeneca Covid-19 Vaccine Administration – First Dose |
TBD |
28 days |
0022A |
ADM SARSCOV2 5X10^10VP.5ML 2 |
AstraZeneca |
AstraZeneca Covid-19 Vaccine Administration – Second Dose |
TBD |
28 days |
Providers can submit claims using the following claim example:
Code | Description | Labeler name | Vaccine/procedure name | Effective date | Dosing interval |
---|---|---|---|---|---|
Q0239* |
bamlanivimab-xxxx |
Eli Lilly |
Injection, bamlanivimab, 700 mg |
11/10/2020 |
28 days |
M0239 |
bamlanivimab-xxxx infusion |
Eli Lilly |
Intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoring |
11/10/2020 |
28 days |
Q0243* |
casirivimab and imdevimab |
Regeneron |
Injection, casirivimab and imdevimab, 2400 mg |
11/21/2020 |
28 days |
M0243 |
casirivi and imdevi infusion |
Regeneron |
Intravenous infusion, casirivimab and imdevimab includes infusion and post administration monitoring |
11/21/2020 |
28 days |
Please Note: Providers should not bill for the cost of the vaccine itself if they received it for free.
Providers can submit claims using the following claim example:
Claim should include the proper billing of the ICD-10 in item 21:
If you’re enrolled in Medicare under these institutional or noninstitutional provider types, you don’t need to take any action to administer and bill the COVID-19 shot, either through individual claims or roster bill, without enrolling as a mass immunizer.
Institutional | Non-Institutional |
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If you’re not enrolled or enrolled under these institutional or non-institutional provider type that do not allow you to bill for administering vaccines, enroll as a mass immunizer.
Institutional | Non-Institutional | Durable Medical Equipment (DME) |
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Hotline for Temporary Enrollment
Mass Immunizer enrolling over the phone is quick and easy.
Important: If NGS is not your MAC, CMS has a list of each MACs enrollment hotline number, state and territory on the COVID-19 MAC Webpages and Hotlines PDF.
Contact Novitas: 855-247-8428
Posted 1/12/2021