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Provider Notice Issued 04/08/2021

Date:     April 8. 2021

 

To:       Enrolled Hospitals:  Chief Executive Officers; Chief Financial Officers; and Patient Accounts Managers

 

Re:      COVID-19 Vaccine Administration Performed in Hospital-Based Outpatient Settings

 

 

This notice informs hospitals of the appropriate process for billing COVID-19 vaccine administration performed in hospital-based outpatient settings. The billing direction applies to claims for persons covered under both traditional fee-for-service and a HealthChoice Illinois managed care plan. 

 

As an exception to current hospital outpatient billing policy, the Department will reimburse COVID-19 vaccine administration in hospital-based outpatient settings via the 837 Professional claim format. While any qualified practitioner can administer the vaccine, hospitals must use the Medical Director, Chief Medical Officer, or other authorized practitioner name and NPI as the Rendering Provider in NM1, Rendering Provider Name, Loop 2310B, on the 837P claim. This authorized practitioner must be registered in IMPACT. The billing information in NMI, Billing Provider Name, Loop 2010AA must be linked to the Rendering Provider Name and NPI.   

 

Institutional claims for vaccine administration that have already been submitted and paid should be voided and the service rebilled through the professional claim format. 

 

The chart below identifies the current coding and rate structure for vaccine administration. Hospitals are encouraged to refer to the COVID-19 Updates webpage for the most up-to-date COVID-19 provider information, including updated COVID-19 fee schedules.

 

Procedure Code

Effective Date

Description

Effective for Claims with DOS on or after 03/15/2021

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

 

0001A

3/15/2021

Pfizer-Biontech COVID-19 Vaccine Administration – First Dose

 

$42.14

0002A

12/11/2020

Pfizer-Biontech COVID-19 Vaccine Administration – Second Dose

$28.39

0002A

3/15/2021

Pfizer-Biontech COVID-19 Vaccine Administration – Second Dose

$42.14

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

0011A

3/15/2021

Moderna COVID-19 Vaccine Administration – First Dose

$42.14

0012A

 

12/18/2020

Moderna COVID-19 Vaccine Administration – Second Dose

$ 28.39

0012A

3/15/2021

Moderna COVID-19 Vaccine Administration – Second Dose

$42.14

91303

02/27/2021

Janssen Covid-19 Vaccine

N/A (currently government-supplied at no cost to the provider)

0031A

02/27/2021

Janssen Covid-19 Vaccine Administration

$28.39

0031A

03/15/2021

Janssen Covid-19 Vaccine Administration

$42.14

 

Per the Centers for Medicare & Medicaid Services, as a condition of receiving free COVID-19 vaccines from the federal government, vaccine providers are prohibited from charging patients any amount for administration of the vaccine and may not deny a vaccine to anyone regardless of income, immigration, or insurance status. For individuals who are uninsured, providers may submit claims for reimbursement of COVID-19 vaccine administration through the federal HRSA COVID-19 Claims Reimbursement Portal.

 

Vaccine administration billing questions should be directed to a professional billing consultant in the Bureau of Professional and Ancillary Services at 877-782-5565. 

 

 

Kelly Cunningham, Administrator

Division of Medical Programs

 

 

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Illinois Healthcare and Family Services

JB Pritzker, Governor • Theresa Eagleson, Director

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