CPT Codes for COVID-19 Vaccinations, Encounters

TargetHIV

The Centers for Medicare and Medicaid Services (CMS) explained reimbursement codes to use for COVID-19 vaccinations and patient encounters in their August 19, 2021 listserv.

Read this excerpt from their bulletin issue, COVID-19 Vaccine News: Recent updates regarding additional doses of the COVID-19 vaccine:

"The CMS Center for Medicare has announced that the Medicare program will be using Current Procedural Terminology (CPT) code 003A for the Pfizer vaccine and 0013A for the Moderna vaccine. More information can be found here. States should ensure that their Medicaid and CHIP providers use these standard procedure codes for COVID-19 vaccination claims and encounters.

State Medicaid and Children’s Health Insurance Program (CHIP) agencies must cover COVID-19 vaccine administration with no cost sharing for nearly all enrollees during the COVID-19 public health emergency (PHE) and (generally) for over a year after it ends.  This coverage would also include the administration of an additional vaccine dose for those who are immunocompromised.  In addition, the American Rescue Plan Act of 2021 (ARP) provides for a temporary 100% federal medical assistance percentage (FMAP) and CHIP enhanced FMAP for amounts expended by a state for medical assistance for COVID-19 vaccines and their administration.  Please refer to the Coverage and Reimbursement of COVID-19 Vaccines, Vaccine Administration, and Cost Sharing under Medicaid, the Children’s Health Insurance Program, and Basic Health Program toolkit for more information."

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