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January 27, 2021

Reason Code 7CS17: Billing COVID-19 Vaccine Administration for Beneficiaries with Medicare Advantage Plans

Some home health and hospice claims submitted for the COVID-19 vaccine administration have been rejected with reason code 7CS17 because the patient is enrolled in a Medicare Advantage (MA) Plan.  As indicated on the Centers for Medicare & Medicaid Services Medicare Billing for COVID-19 Vaccine Shot AdministrationExternal Website website, claims the COVID-19 vaccine administration for patients who are enrolled in a MA Plan, should be submitted to the Medicare Administrative Contractor (MAC), like CGS, not the MA Plan.  To avoid claims rejecting with reason code 7CS17, providers need to include condition code 78 (newly covered Medicare service for which a Health Maintenance Organization (HMO) does not pay).

If your COVID-19 vaccine administration claim has been rejected with 7CS17, and the patient is enrolled in an MA Plan, please resubmit your claim.

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