Date: September 9, 2021
To: Enrolled Physicians, Advanced Practice Nurses, Physician Assistants, Local Health Departments, Federally Qualified Health Centers, Rural Health Clinics, and Encounter Rate Clinics
Re: Updates: Procedure Code M0201 – Add-On for In-Home COVID-19 Vaccination; Administration of 3rd COVID-19 Vaccine
This notice informs providers of an update in the use of procedure code M0201 for reimbursement for COVID-19 vaccination administration provided in the home specifically for patients who have difficulty leaving their homes or are hard-to-reach. It also confirms to providers the availability of a third COVID-19 booster vaccine eight months from a customer's second vaccine dose. These policies apply to claims for participants covered under both traditional Medicaid fee-for-service and the HealthChoice Illinois Medicaid managed care plans.
M0201 – COVID-19 Vaccine Home Administration
Per guidance from the federal Centers for Medicare & Medicaid Services, effective with dates of service beginning August 24, 2021, health care providers can now receive additional payments for administering vaccines to multiple residents in one home setting or communal setting of a home. The updated billing policy allows vaccine providers to receive the increased payment for M0201 up to 5 times when fewer than 10 Medicare beneficiaries get the vaccine on the same day in the same home or communal setting. This includes second and third doses of vaccine. This policy will help ensure that at-risk patients in smaller settings have the same opportunities as others to receive the vaccination and is consistent with Medicare Payment for COVID-19 Vaccination Administration in the Home. All other billing requirements related to the M0201 payment add-on remain the same as outlined in the Department's July 2, 2021 initial provider notice.
3rd Dose COVID-19 Vaccination
Providers may bill for the administration of a third COVID-19 vaccine dose for dates of service beginning August 12, 2021. The 3rd vaccine dose is to be given eight months after a customer's second vaccine dose. Vaccine administration for the uninsured should be billed through the federal HRSA COVID-19 Claims Reimbursement Portal.
The COVID-19 Fee Schedule has been updated regarding both M0201 and the new codes for the third dose vaccine administration. Questions regarding this notice may be directed to a billing consultant in the Bureau of Professional and Ancillary Services at 877-782-5565, or the applicable managed care plan.
Kelly Cunningham, Administrator
Division of Medical Programs