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Are COVID-19 Vaccine Boosters Covered by Medicare?

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Are COVID-19 Vaccine Boosters Covered by Medicare?

The delta variant of COVID-19 has raised a global alarm and is sweeping across nations. Government and healthcare workers are fighting tooth and nail to ensure a faster immunization drive.

While many are receiving their 1st or 2nd vaccine dose, the CMS has also announced that the Medicare would cover the administrative costs of the additional/booster dose. This news is quite encouraging for Americans including the healthcare industry and revenue cycle management service providers.

A study published in the journal ‘Nature’ found that the new variant readily invades the immune response of humans achieved through previous infections or vaccine. Despite such findings, high vaccine effectiveness does not go unnoticed as quite low hospitalization and death rates are seen among vaccinated individuals as compared to the unvaccinated.

US Food and Drug Administration, on 12th Aug 2021, recommended an additional shot of the vaccine for moderate to severely immunocompromised individuals. Additionally pharmaceutical companies like Pfizer are also suggesting booster shots 8 months after the second dose (this is subject to US FDA and CDC’s advisory committee).

Immunocompromised individuals have a debilitated immune system making them more susceptible to getting infected with the coronavirus. Currently CDC recommends the additional shot to the following people:

Important Notes for Healthcare Providers & Revenue Cycle Management Companies

Based on latest CMS guidelines, the cost of administering the booster or additional dose of vaccine will not be borne by the patient, rather it will be covered by Medicare. So, providers must bill accordingly.

The CPT codes for booster dose of vaccines in US

  Manufacturer   Vaccine Code   Administration Codes
  Pfizer   91300   • 0001A (1st dose)
  • 0002A (2nd dose)
  • 0003A (3rd dose)
  Moderna   91301   • 0011A (1st dose)
  • 0012A (2nd dose)
  • 0013A (3rd dose)

The above codes released by American Medical Association (AMA) can only be used for additional dose of immunocompromised individuals. The US Government has announced that they shall make booster shots available to the overall population but formal guidelines and approval from US FDA are yet to be received.

Costs are a barrier in a much-needed immunization drive and COVID-19 does not look like it is going away any time soon. Therefore, this news of additional dose coverage by Medicare is a relief for healthcare and people alike. With no out of pocket costs, getting a vaccine is a lot easier and simpler for Americans.

As a healthcare provider, you can keep up with faster vaccine administration and an improved revenue management cycle by outsourcing medical billing to leading companies like Astron EHS. The team of expert billers are well acquainted with updated billing codes and Payor or Medicare policies and requirements. It is always a good time to reduce your hassle. Why not start today?