CurrentsimplyhealthcarePolicy N/A

COVID-19 vaccine administration - billing

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This document explains Simply Healthcare Plans, Inc. and Clear Health Alliance reimbursement and billing policies for administration of COVID-19 vaccines to plan members, including billing instructions for participating and non-plan participating providers with a Florida Medicaid ID.

Policy Summary

Payersimplyhealthcare

PolicyCOVID-19 vaccine administration - billing

Policy CodePolicy N/A

Change TypeNo material change

Effective DateApr 1, 2022

Next Review DateN/A

Key ActionAdministration of COVID-19 vaccines does not require prior authorization.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

No prior auth requiredPrior authorization for COVID-19 vaccine administration

No copayCopayments for vaccine administration and associated office visit

$40 / $32Typical administration reimbursement

SMPLYElectronic claims payer identifier

Coverage and Billing Rules

Coverage and billing rules

Billing rules vary by member insurance type and there are no copayments for vaccine administration or the office visit where administered.

ALL of the following

Member insurance type - bill appropriate payer
- Medicare and Medicaid dual-eligibles: Providers must bill Medicare for the administration of COVID-19 vaccines for members with both Medicare and Medicaid.
- Medicaid-only members: Providers must bill the health plan (Simply or Clear Health Alliance) for members with Medicaid only.
- Members with other insurance: Providers must bill the other insurer first for members who have other primary coverage.
Cost sharing: There are no co-payments for COVID-19 vaccine administration and vaccine products, including no copayment for a physician office visit at which the vaccine is administered.
Prior authorization: Administration of COVID-19 vaccines does not require prior authorization.
Provider participation and billing: Simply and Clear Health Alliance will reimburse participating providers and non-plan participating providers with a Florida Medicaid Identification Number; there are no additional billing requirements or exceptions for non-plan participating providers.

COVID-19 Vaccine and Administration Codes

COVID-19 vaccine and administration codesmixedCovered

91300	SARSCOV2 VAC 30MCG/0.3ML IM
0001A	ADM SARSCOV2 30MCG/0.3ML 1ST
0002A	ADM SARSCOV2 30MCG/0.3ML 2ND
003A	ADM SARSCOV2 30MCG/0.3ML 3RD
004A	ADM SARSCOV2 30MCG/0.3ML BOOSTER
91307	SARSCOV2 VAC 10MCG PEDIATRIC
0071A	ADM SARSCOV2 10MCG PEDIATRIC 1ST
0072A	ADM SARSCOV2 10MCG PEDIATRIC 2ND
91301	SARSCOV2 VAC 100MCG/0.5ML IM
0011A	ADM SARSCOV2 100MCG/0.5ML 1ST

1–10 of 17

1/2

Physician/Extender rate — reimbursement amounts for administration codes

Physician administration reimbursement$40.00 per listed vaccine administration CPT/HCPCS code (physician rate)

Extender administration reimbursement$32.00 per listed vaccine administration CPT/HCPCS code (extender rate)

Codes with $0.00 product rateVaccine product CPT/HCPCS codes (e.g., 91300, 91307, 91306, 91303) show $0.00 physician and extender product amounts where applicable

Effective datesAdministration rates became effective on the dates listed per code (examples: 3/15/2021, 8/12/2021, 9/22/2021, 10/29/2021, 10/20/2021)

Provider Requirements & Actions

Prior Authorization

No prior authorization required

Administration of COVID-19 vaccines does not require prior authorization.

Providers and Rate Definitions

Covered providers

Covered providers — participating providersSimply and Clear Health Alliance will reimburse participating providers for COVID-19 vaccine administration to plan members

Covered providers — non‑plan participating providersSimply and CHA will reimburse non‑plan participating providers that have a Florida Medicaid Identification Number; there are no additional billing requirements or exceptions

Prior authorization for providersAdministration of COVID-19 vaccines does not require prior authorization

Billing scopeReimbursement applies to administration of COVID-19 vaccines rendered to Simply and CHA Medicaid members

Policy Summary

Payersimplyhealthcare

PolicyCOVID-19 vaccine administration - billing

Policy CodePolicy N/A

Change TypeNo material change

Effective DateApr 1, 2022

Next Review DateN/A

Key ActionAdministration of COVID-19 vaccines does not require prior authorization.

SourceLink

On This Page

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CurrentsimplyhealthcarePolicy N/A

COVID-19 vaccine administration - billing

Customize your policy alerts

Sign up for all simplyhealthcare policy alerts

Know when simplyhealthcare releases new policies or updates existing guidance.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Policy Summary

Payersimplyhealthcare

PolicyCOVID-19 vaccine administration - billing

Policy CodePolicy N/A

Change TypeNo material change

Effective DateApr 1, 2022

Next Review DateN/A

Key ActionAdministration of COVID-19 vaccines does not require prior authorization.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

No prior auth requiredPrior authorization for COVID-19 vaccine administration

No copayCopayments for vaccine administration and associated office visit

$40 / $32Typical administration reimbursement

SMPLYElectronic claims payer identifier

Coverage and Billing Rules

Coverage and billing rules

Billing rules vary by member insurance type and there are no copayments for vaccine administration or the office visit where administered.

ALL of the following

Member insurance type - bill appropriate payer
- Medicare and Medicaid dual-eligibles: Providers must bill Medicare for the administration of COVID-19 vaccines for members with both Medicare and Medicaid.
- Medicaid-only members: Providers must bill the health plan (Simply or Clear Health Alliance) for members with Medicaid only.
- Members with other insurance: Providers must bill the other insurer first for members who have other primary coverage.
Cost sharing: There are no co-payments for COVID-19 vaccine administration and vaccine products, including no copayment for a physician office visit at which the vaccine is administered.
Prior authorization: Administration of COVID-19 vaccines does not require prior authorization.
Provider participation and billing: Simply and Clear Health Alliance will reimburse participating providers and non-plan participating providers with a Florida Medicaid Identification Number; there are no additional billing requirements or exceptions for non-plan participating providers.

COVID-19 Vaccine and Administration Codes

COVID-19 vaccine and administration codesmixedCovered

91300	SARSCOV2 VAC 30MCG/0.3ML IM
0001A	ADM SARSCOV2 30MCG/0.3ML 1ST
0002A	ADM SARSCOV2 30MCG/0.3ML 2ND
003A	ADM SARSCOV2 30MCG/0.3ML 3RD
004A	ADM SARSCOV2 30MCG/0.3ML BOOSTER
91307	SARSCOV2 VAC 10MCG PEDIATRIC
0071A	ADM SARSCOV2 10MCG PEDIATRIC 1ST
0072A	ADM SARSCOV2 10MCG PEDIATRIC 2ND
91301	SARSCOV2 VAC 100MCG/0.5ML IM
0011A	ADM SARSCOV2 100MCG/0.5ML 1ST

1–10 of 17

1/2

Physician/Extender rate — reimbursement amounts for administration codes

Physician administration reimbursement$40.00 per listed vaccine administration CPT/HCPCS code (physician rate)

Extender administration reimbursement$32.00 per listed vaccine administration CPT/HCPCS code (extender rate)

Codes with $0.00 product rateVaccine product CPT/HCPCS codes (e.g., 91300, 91307, 91306, 91303) show $0.00 physician and extender product amounts where applicable

Effective datesAdministration rates became effective on the dates listed per code (examples: 3/15/2021, 8/12/2021, 9/22/2021, 10/29/2021, 10/20/2021)

Provider Requirements & Actions

Prior Authorization

No prior authorization required

Administration of COVID-19 vaccines does not require prior authorization.

Providers and Rate Definitions

Covered providers

Covered providers — participating providersSimply and Clear Health Alliance will reimburse participating providers for COVID-19 vaccine administration to plan members

Prior authorization for providersAdministration of COVID-19 vaccines does not require prior authorization

Billing scopeReimbursement applies to administration of COVID-19 vaccines rendered to Simply and CHA Medicaid members

Policy Summary

Payersimplyhealthcare

PolicyCOVID-19 vaccine administration - billing

Policy CodePolicy N/A

Change TypeNo material change

Effective DateApr 1, 2022

Next Review DateN/A

Key ActionAdministration of COVID-19 vaccines does not require prior authorization.

SourceLink

On This Page