Medical Coding for COVID-19 Treatment & Vaccinations – Are you ready for this?
There seems to be no end in sight for the pandemic with the third novel Coronavirus wave upon us. With US Government and healthcare organizations encouraging immunization, providers and medical billing companies must be updated with the guidelines for coding and billing COVID-19 treatments and vaccinations, Medical Coding for COVID-19 Treatment & Vaccinations. The system is already stressed and adapting to these new systems can be vulnerable to account receivables going awry.
States and payors have come up with many policies regarding payment, cost-sharing, waivers, and authorization. For example, providers cannot bill for the vaccine itself as they receive it for free from the government but can bill for administering it based on CMS reimbursement rates.
Understanding such facts and more is essential in medical Billing and medical Coding for COVID-19 treatments and vaccination. So, are you ready for it?
Let us bring you up to date with the rules and codes.
Since April 2020, the CMS (Centers for Medicare and Medicaid Services) has developed many ICD-10-PCS codes for COVID-19 treatment and vaccination.
Immunization administration by IM injection for SARS-Cov2vaccine. mRNA-LNP, spike protein, preservative free, 30mcg/0.3mL dose, diluent reconstituted, the first dose. (This code is for the first dose of Pfizer vaccine only)
Immunization administration by IM injection for SARS-Cov2 vaccine. mRNA-LNP, spike protein, preservative free, 30mcg/0.3mL dose, diluent reconstituted, the second dose. (This code is for the second dose of Pfizer vaccine only)
Immunization administration by IM injection for SARS-Cov2 vaccine. mRNA-LNP, spike protein, preservative-free, 100mcg/0.5mL dose, first dose. (This code is for the first dose of Moderna vaccine only)
Immunization administration by IM injection for SARS-Cov2 vaccine. mRNA-LNP, spike protein, preservative-free, 100mcg/0.5mL dose, second dose. (This code is for the second dose of Moderna vaccine only)
Similarly, 0031A is for the administration of the Janssen Vaccine. To get reimbursed for vaccine administration, providers have to use the right codes for better tracking, analysis, and reporting.
CMS has set payment allowances as $16.94 for the first dose of a vaccine and $28.39 for the second dose and will reimburse providers under Medicare Part B.
Of course, the providers must be enrolled in Medicare to be able to bill as either a series of single claims or roster billing of a minimum of 5 patients on the same day of service. Most private payors are also providing payment allowances for vaccine administration at the same rates as the CMS.
For institutional claims, the following types of bills are valid for roster billing:
- 12X, Hospital Inpatient
- 13X, Hospital Outpatient
- 22X, Skilled Nursing Facility (SNF) covered Part A stay (paid under Part B) and Inpatient Part B
- 23X, SNF Outpatient
- 34X, Home Health (Part B Only)
- 72X, Independent and Hospital-based Renal Dialysis Facility
- 75X, Comprehensive Outpatient Rehabilitation Facility
- 81X, Hospice (Non-hospital)
- 82X, Hospice (Hospital)
- 85X, Critical Access Hospital
The billing processes can vary for Medicare or Medicaid programs and private payors. So, it is ideal for the provider or their medical billing company to communicate with the appropriate point of contact about the patient’s plan. This way streamline and smooth account receivables management will be achieve.
COVID-19 Treatment Billing
A previous analysis claimed that out-of-pocket costs for in-patient admission and COVID-19 treatment for patients on private insurance plans could exceed $1300. But by now, many payors have waived out-of-pocket costs for COVID-19 testing and have waived cost sharing for COVID-19 treatments. Such policy updates make a huge impact on medical billing.
For e.g.: Cigna has waved cost sharing until October 17, 2021, for testing and for telehealth. Humana has waived out-of-pocket costs for testing, treatment, and telehealth through the 2021 plan year. It is important to make a note of the expiration dates of such mandates and stay informed about any extension announcements from the payors and state.
Also, policies and billing processes vary for each payor. Cigna has waived prior authorization for COVID-19 evaluations, testing, or treatment, but requires routine and non-emergent transfers. Humana does not require prior authorization for those who test positive for the novel Coronavirus.
Efficient & Accurate COVID-19 Billing with Astron EHS
The dynamic nature of the pandemic and thus the policies and codes for testing, treatment, and immunization for COVID-19, stress the importance of opting for services of a medical billing company for account receivables services. This will not only bring profits but will reduce your administrative responsibilities too.
Astron EHS provides expert and reliable billing services to providers across the USA. We ensure timely and accurate payments or accounts receivables from Medicare, Medicaid, and Commercial Payors.
Our experience and knowledge of relevant codes for COVID-19 billing as well as our customized affordable payment plans set us apart.
For more information, get in touch with us!