As the COVID-19 vaccine becomes available to younger patients and more pediatric practices provide the vaccine, it will be important to know how to code and bill properly for vaccine administration, including for patients without insurance or on Medicare.
The Academy has developed the COVID-19 Vaccine Administration: Getting Paid website, http://bit.ly/AAPcovid19coding, to guide members through the coding and billing process. The website will be updated when COVID-19 vaccines are granted emergency use authorization and when the American Medical Association develops new Current Procedural Terminology codes.
Resources on the website guide members on how to bill private payers, Medicaid plans and Medicare. If a patient is dual eligible for Medicare and Medicaid, the practice will bill Medicare for the COVID-19 vaccine.
Pay attention to your COVID-19 vaccine claims. Report any payments for vaccine administration that are below $40, the value assigned by the Centers for Medicare & Medicaid Services, to the AAP Coding Hotline (see resource).
Do not report the CPT product code unless instructed by the payer. The COVID-19 immunization administration codes are specific to the manufacturer and dose. Therefore, some payers may inappropriately believe the vaccine product code is unnecessary since it is not a billable service and deny the claim.
Most importantly, it is a violation of federal law for a payer or a practice to charge any patient or family member for COVID-19 immunization administration. Report violations to the Department of Health and Human Services at https://oig.hhs.gov/fraud/report-fraud/index.asp.