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