CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

Payment Policy COVID-19 Vaccinations

This policy describes BCBSRI's payment and billing stance for FDA-authorized COVID-19 vaccines and associated administration services for applicable members, including waiver of member cost-sharing and coding/billing guidance.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyPayment Policy COVID-19 Vaccinations

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateJan 1, 2020

Next Review DateN/A

Key ActionDo not append modifier 22 to vaccine product codes; claims with modifier 22 will be denied and should be refiled without it.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

no cost sharemember cost sharing waived for COVID-19 vaccines and administration

Z23recommended ICD-10 code for encounter for immunization

no reimbursementpayment stance for free vaccine product

Modifier 22billing rule leading to denial if used on vaccine codes

Coverage Criteria

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inv-01: Coverage rules — Coverage and member cost-share requirements for COVID-19 vaccines and administration

Covered when ALL of the following are met:

FDA-approved COVID-19 vaccines and associated administration services are covered with no member cost-sharing when recommended by the CDC/AAP and FDA guidelines are met.

No member cost share (eg, deductibles, copayments, coinsurance) will be imposed for COVID-19 vaccines or associated administration services while this policy is in effect.

Evaluation & Management (E/M) services must not be filed for visits solely for COVID-19 vaccine administration unless the E/M represents a separately identifiable service and modifier 25 is appended.

When vaccine product doses are supplied to providers at no cost, providers must still file the appropriate vaccine product and administration codes for reporting and data collection; do not append modifier 22 to vaccine product codes.

inv-02: COVID-19 vaccine coding and reimbursement — Coverage and billing rules for COVID-19 vaccines and administration codes included in this section:

Coverage and billing rules for COVID-19 vaccines and administration codes included in this section:

There is no reimbursement for vaccine products that health care providers receive at no cost; providers must file the vaccine product codes for reporting and data collection purposes.

Providers must not append modifier 22 to vaccine product codes; claims submitted with modifier 22 will be denied and should be refiled without modifier 22.

Recommended vaccine product HCPCS codes (to be filed even if vaccine received at no cost): 91300 (Pfizer-BioNTech), 91301 (Moderna), 91302 (AstraZeneca).

Manufacturer-specific administration codes covered (examples): Pfizer-BioNTech and Moderna manufacturer administration CPT/HCPCS codes and AstraZeneca administration codes — see coding list for exact administration codes (eg, 0001A/0002A, 0011A/0012A, 0021A/0022A as applicable).

Follow Medicare guidance for BlueCHiP for Medicare enrollees as applicable (submit vaccine and administration codes per Medicare rules).

Coding and Billing

COVID-19 vaccine product and administration codesmixedCovered

Z23	Encounter for immunization
0001A	Pfizer-BioNTech COVID-19 vaccine administration — first dose
0002A	Pfizer-BioNTech COVID-19 vaccine administration — second dose
0011A	Moderna COVID-19 vaccine administration — first dose
0012A	Moderna COVID-19 vaccine administration — second dose
0021A	AstraZeneca COVID-19 vaccine administration — first dose
0022A	AstraZeneca COVID-19 vaccine administration — second dose
91300	Pfizer-BioNTech COVID-19 vaccine product code
91301	Moderna COVID-19 vaccine product code
91302	AstraZeneca COVID-19 vaccine product code

Pfizer-BioNTech product codeHCPCSCovered

91300

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19) for intramuscular use

Moderna product codeHCPCSCovered

91301

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19) vaccine; mRNA-LNP, 100 mcg/0.5 mL; for intramuscular use

AstraZeneca product codeHCPCSCovered

91302

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19) vaccine, DNA, spike protein, chimpanzee adenovirus Oxford 1 (ChAdOx1) vector; for intramuscular use

Manufacturer-specific administration codesCPTCovered

0011A	Moderna immunization administration by intramuscular injection; first dose
0012A	Moderna immunization administration by intramuscular injection; second dose
0021A	AstraZeneca immunization administration by intramuscular injection; first dose
0022A	AstraZeneca immunization administration by intramuscular injection; second dose

Medicare billing — BlueCHiP for Medicare

Action for BlueCHiP for Medicare enrolleesSubmit COVID-19 vaccine product and administration codes to Original Medicare; do not bill BCBSRI for BlueCHiP for Medicare services.

Applicable guidance sourceFollow CMS guidelines for submission of vaccine and administration codes to Original Medicare for Medicare Advantage enrollees.

TimeframeApplies to services billed in 2020 and 2021 as specified by CMS guidance in this policy.

Vaccine product reimbursement for free‑supplied doses

Reimbursement stanceNo reimbursement for vaccine products that providers receive at no cost; vaccine product will not be paid.

Reporting requirementProviders must still file the specified vaccine product codes for reporting and data collection purposes even when vaccine was received at no cost.

Modifier instructionDo not append modifier 22 to vaccine product codes indicating provider purchase; claims with modifier 22 will be denied and must be refiled without it.

Provider Actions and Billing Rules

Prior Authorization

Prior authorization not applicable

Prior authorization is not required for COVID-19 vaccines or their administration under this policy.

Billing Rule

Do not append modifier 22 to vaccine product codes

Do not append modifier 22 to COVID-19 vaccine product codes; claims submitted with modifier 22 will be denied and must be refiled without modifier 22.

If claims for vaccine codes are submitted with modifier 22 appended, the claim for the vaccine will be denied.
Providers should refile the vaccine code without a 22 modifier.

Definitions

Emergency Use Authorization (EUA)

DefinitionEmergency Use Authorization (EUA): A statutory mechanism by which the FDA may allow distribution of a medical product (e.g., COVID‑19 vaccines) during a public health emergency when criteria are met.

Pfizer‑BioNTech EUA datePfizer‑BioNTech COVID‑19 Vaccine EUA issued December 11, 2020.

Moderna EUA dateModerna COVID‑19 Vaccine EUA issued December 18, 2020.

Context noteEUA determination is based on available safety and effectiveness data showing that known and potential benefits outweigh known and potential risks.

Vaccine product codes — reporting requirement

Filing requirementProviders must file the specified COVID‑19 vaccine product codes (e.g., 91300, 91301, 91302) for reporting and data collection even when the vaccine was received at no cost.

Example product codes91300 (Pfizer‑BioNTech), 91301 (Moderna), 91302 (AstraZeneca) — listed as vaccine product codes in this policy.

No payment for free dosesVaccine product codes filed for vaccines received at no cost will not be reimbursed; filing is for reporting only.

Modifier warningDo not append modifier 22 to vaccine product codes; claims submitted with modifier 22 will be denied and should be refiled without it.