When COVID-19 vaccine and monoclonal antibody doses are provided by the government without charge, only bill for the vaccine administration. Beneficiary coinsurance and deductible are waived. Don’t bill the vaccine codes on the claim when the vaccines are free. If the patient is enrolled in a Medicare Advantage (MA) plan, submit these claims to original Medicare in 2020 and 2021.

Types of Bills

• 12X, 13X - Hospital (use date of discharge or date Part A benefits exhaust as date of service)
• 22X, 23X - Skilled Nursing Facility
• 72X - End Stage Renal Disease
• 75X - Comprehensive Outpatient Rehabilitation Facility
• 85X - Critical Access Hospital

Revenue Codes

• 0771 - Preventive care services, vaccine administration
• 0636 - Pharmacy, drugs required detailed coding

Condition Codes

• A6 - 100% payment
• 78 - New coverage not implemented by Medicare Advantage (Medicare Advantage beneficiaries only)

Diagnosis Codes

• Z23 - encounter for immunization
• U07.1 (monoclonal antibodies only)

Rural Health Clinics (RHC)and Federally Qualified Health Centers (FQHC)

Independent and provider-based rural health clinics (RHC) and federally qualified health centers (FQHC) do not include charges for the COVID-19 vaccine and monoclonal antibodies on a claim form.

Administration of these vaccines does not count as a visit when the only service involved is the administration of the COVID-19 vaccine and/or monoclonal antibodies.

If there was another reason for the visit, the RHC/FQHC should bill for the visit without adding the cost of the COVID-19 vaccine and/or monoclonal antibodies to the charge for the visit on the bill.

Payment is made at the time of cost settlement.

Skilled Nursing Facilities - Enforcement Discretion to Certain Pharmacy Billing

In order to facilitate the efficient administration of COVID-19 vaccines and monoclonal antibody treatments to Skilled Nursing Facility (SNF) residents, CMS will exercise enforcement discretion with respect to these statutory provisions as well as any associated statutory references and implementing regulations, including as interpreted in pertinent guidance, SNF CB Provisions. Through the exercise of that discretion, CMS will allow Medicare-enrolled immunizers, including but not limited to pharmacies working with the United States, to bill directly and receive direct reimbursement from the Medicare program for vaccinating Medicare SNF residents.

CMS will exercise such discretion:

• During the emergency period defined in paragraph (1)(B) of section 1135(g) of the Social Security Act (42 U.S.C. § 1320b-5(g)) and ending on the last day of the calendar quarter in which the last day of such emergency period occurs; or
• So long as CMS determines that there is a public health need for mass COVID-19 vaccinations in congregate care settings, whichever is later

For roster billing and centralized billing reference, visit the CMS Medicare Billing for COVID-19 Vaccine Shot Administration webpage.

For payment allowances and other information, including the HCPCS/CPT codes, visit the CMS COVID-19 Vaccines and Monoclonal Antibodies webpage.

Resources

• CDC COVID-19 Vaccination Communication Toolkit for Health Systems and Clinics
• CMS COVID-19 Frequently Asked Questions (FAQs) on Medicare Fee-for-Service (FFS) Billing
• CMS COVID-19 Provider Toolkit
• FDA: COVID-19 Vaccines
• CMS Monoclonal Antibody COVID-19 Infusion
• CMS SNF: Enforcement Discretion Relating to Certain Pharmacy Billing
• CMS COVID-19 toolkit issuers MA plans