February 2, 2021 – Revised June 8, 2021
COVID-19 Vaccine and Monoclonal Antibody Infusion – Part A / HH&H Billing Guidance
The information below will assist Medicare Part A, home health, and hospice providers with proper billing of single claims for COVID-19 vaccines and monoclonal antibody infusions. For additional information related to roster billing and centralized billing, reference the CMS Medicare Billing for COVID-19 Vaccine Shot Administration page.
General
When COVID-19 vaccine and monoclonal antibody doses are provided by the government without charge, bill for the vaccine administration only. Do not include the vaccine codes on the claim when the vaccines are free.
Update: CMS recognizes that many provider billing systems and/or other payers require a charge to be submitted, even when a product is provided for free or without charge. In this instance, institutional providers must report the applicable drug HCPCS code and appropriate units with a token charge of less than $1.01 in the covered and non-covered charge fields.
- For patients enrolled in a Medicare Advantage plan in 2020 and 2021, submit the claim to Original Medicare.
Reminder: The myCGS User Manual is available if the beneficiary is not able to provide their MBI at the time of service.
- Skilled Nursing Facility consolidated billing (SNF CB) edits do not apply.
Type of Bill
- Inpatient Part B:
- Hospital – 12X
- SNF – 22X
NOTE: The date of service = date of discharge or date Part A benefits exhausted.
- Outpatient:
- Hospital – 13X
- SNF – 23X
- Home Health – 34X
- End Stage Renal Disease – 72X
- Comprehensive Outpatient Rehabilitation Facility – 75X
- Hospice – 81X or 82X
- Critical Access Hospital – 85X
Condition Codes
- A6 – 100% payment (COVID-19 vaccines only)
- 78 – New coverage not implemented by Medicare Advantage (if the beneficiary is enrolled in a MA plan)
Effective for claims received on or after February 1, 2021:
- 90 – To allow providers to report when the service is provided as part of an Expanded Access approval
- 91 – To allow providers to report when the service is provided as part of an Emergency Use Authorization (EUA)
Reference: CMS MLN Matters article MM12049
Revenue Codes
- 0771 – Preventive care services, vaccine administration
- 0636 – Pharmacy, drugs requiring detailed coding
NOTE: Do NOT report revenue code 0636 or the product HCPCS code if it was received for free.
Update: CMS recognizes that many provider billing systems and/or other payers require a charge to be submitted, even when a product is provided for free or without charge. In this instance, institutional providers must report the applicable drug HCPCS code and appropriate units with a token charge of less than $1.01 in the covered and non-covered charge fields.
HCPCS Codes
Reference the CMS Vaccine Pricing page for a list of applicable HCPCS codes, payment allowances, and effective dates.
NOTE: Do NOT report the product HCPCS code if it was received for free.
Update: CMS recognizes that many provider billing systems and/or other payers require a charge to be submitted, even when a product is provided for free or without charge. In this instance, institutional providers must report the applicable drug HCPCS code and appropriate units with a token charge of less than $1.01 in the covered and non-covered charge fields.
Diagnosis Codes
- Z23 – Encounter for immunization (COVID-19 vaccines only)
- U071 – COVID-19 (monoclonal antibody infusion only)