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Coding and Billing for Coronavirus immunizations

The American Medical Association (AMA) has published an update to the CPT code set that includes new vaccine-specific codes to report immunizations for the new coronavirus (SARS-CoV-2).  CDC has approved a unique CPT code for each of two coronavirus vaccines as well as administration codes unique to each such vaccine. These CPT codes are available prior to the public availability of the vaccines to facilitate swift updating of health care medical billing systems across the country.

New vaccine administration codes and billing guidelines have been published by CMS that are distinct to each coronavirus vaccine as well as to the specific dose in the required schedule. This helps to track the vaccine usage even when it is administered for free to the patients. Toolkits have been prepared for providers, states and insurers to easily accommodate the changes in the coding and medical billing of the vaccination program. It allows the smooth administration of the vaccine once it is available. Medical billing with these codes ensures adequate reimbursement for administering the vaccine in Medicare. The resources clearly explain to the private insurers and Medicaid programs their liability to cover the vaccine at no charge to recipients.

The CMS guidelines state that providers should administer a COVID-19 vaccine irrespective of an individual’s ability to pay or their coverage status. Also, they cannot seek any reimbursement from a vaccine recipient through patient billing. People lacking health insurance or whose insurance does not provide coverage of the vaccine can also get COVID-19 vaccine at no cost. In such cases providers can request remittance for the vaccine administration through the Provider Relief Fund.


Medical Billing to a COVID-19 World

Catastrophic Plans in Medical Billing

What is a catastrophic plan?

Designed to have low premiums but still protect its enrollee’s from substantial medical debt if they suffer a catastrophic illness. These plans have a major role in Covid-19 crisis.

In medical billing, diagnosis and treatment of COVID-19 can be filed under catastrophic plans. These plans must cover essential health benefits (EHB) as required by the Patient Protection and Affordable Care Act (PPACA) but are typically subject to limitations. Health issuer can amend their catastrophic plans to provide pre-deductible coverage for services related to the diagnosis and treatment of COVID-19. 

Catastrophic plans help patients who can’t afford more comprehensive plans. Though expanded catastrophic plan maybe harder on medical billing systems, reimbursements to hospitals and providers will likely remain the same.