Date: January 7, 2021
To: Enrolled
Physicians, Advanced Practice Nurses, Physician Assistants, Local Health Departments,
Federally Qualified Health Centers, Rural Health Clinics, and Encounter Rate Clinics
Re: COVID-19
Vaccine and Vaccine Administration Billing Information for Practitioners
This notice provides information to practitioners
on current coding and rates, as well as billing guidance for Federally
Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs) and Encounter
Rate Clinics (ERCs) related to the COVID-19 vaccine and its administration. Practitioners
may bill at the time the vaccine becomes available. This billing guidance applies to claims for participants covered under both
traditional Medicaid fee-for-service and the HealthChoice Illinois Medicaid
managed care plans.
COVID-19 vaccine administration procedure codes
are billable by physicians, advanced practice nurses (APNs), physician assistants
(PAs), local health departments, FQHCs, RHCs, and ERCs.
The Department will
reimburse the above clinics for the COVID-19 vaccine administration
fee-for-service outside the normal encounter rate methodology, even if the
vaccine is administered during a face-to face encounter with a practitioner. FQHCs,
RHCs and ERCs must submit COVID-19 vaccine administration codes on a
claim separate from any other codes.
COVID-19 vaccine
administration codes submitted as detail codes along with a T1015 or S5190
encounter will result in a rejection of the encounter claim with error code
G70.
The Department will use the rates below established
for the Medicare program for reimbursement of the administration fees for the
first and second doses of the currently approved vaccines. These administration
rates are applicable only to these specific vaccines. Going forward, providers should refer to the
COVID-19 Fee Schedule, available on the
COVID-19 Updates webpage, for future guidance as new vaccine and vaccine
administration codes are approved by the Centers for Medicare & Medicaid
Services (CMS) and the Federal Drug Administration (FDA).
Currently approved COVID-19 vaccine product
procedure codes are included below as a reference but should not be billed when
the vaccine is obtained at zero cost to the provider.
Procedure Code
|
Effective Date
|
Description
|
State Max Amount
|
91300
|
12/11/2020
|
Pfizer-Biontech COVID-19 Vaccine
|
N/A (currently government-supplied at no cost to the provider)
|
0001A
|
12/11/2020
|
Pfizer-Biontech COVID-19 Vaccine Administration – First Dose
|
$16.94
|
0002A
|
12/11/2020
|
Pfizer-Biontech COVID-19 Vaccine Administration – Second Dose
|
$28.39
|
91301
|
12/18/2020
|
Moderna COVID-19 Vaccine
|
N/A (currently government-supplied at no cost to the provider)
|
0011A
|
12/18/2020
|
Moderna COVID-19 Vaccine Administration – First Dose
|
$16.94
|
0012A
|
12/18/2020
|
Moderna COVID-19 Vaccine Administration – Second Dose
|
$28.39
|
Vaccine administration for the uninsured population should be billed
through the federal HRSA COVID-19
Claims Reimbursement Portal.
The COVID-19 Fee Schedule has been updated with the codes and rates above. Please
check the COVID-19 Updates webpage for the most up to date information related to the
COVID-19 public health emergency.
Questions regarding this notice may be directed to the Bureau of Professional
and Ancillary Services at 877-782-5565.
Kelly Cunningham, Administrator
Division of Medical Programs