Practice Support Update Blog

​NC Medicaid and NC Health Choice COVID-19 Immunization Billing Guidance

Jan 12, 2021 4:52:40 PM / by Practice Support Team

Are you planning on administering COVID-19 Vaccines in your office? 

NCDHHS has shared the Medicaid and NC Health Choice billing guidance for both the Pfizer-BioNTech and Moderna vaccines in two Special Bulletins (#147 and #148).  Please see some of the billing highlights and links to the bulletins below. 


Pfizer-BioNTech COVID-19 Vaccine Billing Guidelines 

covidvaccineEffective with date of service Dec 12, 2020, the Medicaid and NC Health Choice programs cover Pfizer-BioNTech COVID-19 Vaccine for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code 91300 - Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3mL dosage, diluent reconstituted, for intramuscular use. 

 

COVID-19 Vaccine Billing Codes for Medicaid Beneficiaries

Vaccine CPT Codes to Report

Vaccine CPT Code to Report

NDC

CPT Code Description

91300

59267-1000-01,
59267-1000-02,
59267-1000-03

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3mL dosage, diluent reconstituted, for intramuscular use

Administrative CPT Codes to Bill

Administration CPT Code(s) to Bill

CPT Code Description

0001A

Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3mL dosage, diluent reconstituted; first dose

0002A

Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3mL dosage, diluent reconstituted; second dose

 

Moderna COVID-19 Vaccine Billing Guidelines 

COVID-19 Vaccine Billing Codes for Medicaid and NC Health Choice Beneficiaries

Administration CPT Codes to Bill

Administration CPT Code(s) to Bill

CPT Code Description

0011A

Immunization administration by intramuscular injection of Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5mL dosage; first dose

0012A

Immunization administration by intramuscular injection of Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5mL dosage; second dose

Vaccine CPT Code to Report

Vaccine CPT Code to Report

NDC

CPT Code Description

91301

80777-0273-10
80777-0273-99

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5mL dosage, for intramuscular use

 

For more detailed billing information check out the link to the Special Bulletins below. 

SPECIAL BULLETIN COVID-19 #148: Pfizer-BioNTech COVID-19 Vaccine (N/A) HCPCS Code 91300: Billing Guidelines 

SPECIAL BULLETIN COVID-19 #147: Moderna COVID-19 Vaccine (N/A) HCPCS code 91301: Billing Guidelines 

Tags: Medicaid, COVID-19, Billing, coding

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