Medical Coding Guidelines for COVID-19 Treatment and Vaccinations
With COVID-19 vaccinations now being administered across the United States, we have compiled this list of medical code sets to account for the treatment and vaccinations for the novel Coronavirus.
ICD-10 Codes for COVID-19
The World Health Organization (WHO) has developed an ICD-10-CM code for COVID-19: U07.1 COVID-19. These codes were adopted by the Centers for Disease Control and Prevention (CDC) adopted the code in March 2020. The regulation became effective on April 1, 2020.
Since April 2020, the Centers for Medicare and Medicaid Services (CMS) has developed over 20 ICD-10-PCS codes for documenting COVID-19 treatments and vaccines. Six of these codes are for vaccine administration, and they include:
| XW013S6 | Introduction of COVID-19 vaccine dose one into the subcutaneous tissue, percutaneous approach, new technology group 6 |
| XW013T6 | Introduction of COVID-19 vaccine dose two into the subcutaneous tissue, percutaneous approach, new technology group 6 |
| XW013U6 | Introduction of COVID-19 vaccine into the subcutaneous tissue, percutaneous approach, new technology group 6 |
| XW023S6 | Introduction of COVID-19 vaccine dose one into muscle, percutaneous approach, new technology group 6 |
| XW023T6 | Introduction of COVID-19 vaccine dose two into muscle, percutaneous approach, new technology group 6 |
| XW023U6 | Introduction of COVID-19 vaccine into muscle, percutaneous approach, new technology group 6 |
CMS states that the new PCS codes will "describe the introduction or infusion of therapeutics, including monoclonal antibodies and vaccines for COVID-19 treatment." The codes also include vaccines like the one from Pfizer and BioNTech that require two doses.
However, for hospitalized patients, Medicare will pay for the COVID-19 vaccine and its administration separately from the Diagnosis-Related Group rate. To be reimbursed for administering the vaccine to Medicare beneficiaries, the hospital must use the right CPT codes.
CPT Codes
The American Medical Association (AMA) has already released CPT codes for reporting of COVID-19 vaccines.
| Vaccine | Emergency Use Authorization | Code for the First Dose | Code for the Second Dose |
|---|---|---|---|
| Pfizer-BioNTech vaccine | Approved | 0001A | 0002A |
| Moderna | In review | 0011A | 0012A |
Getting Reimbursed for Vaccine Administration
For getting reimbursed, providers must use the right medical codes for vaccine administration. CMS states that it will reimburse providers under Medicare Part B, rather than Part D, to ensure broad coverage of the vaccine. Since providers received the vaccines free from the government, they cannot bill Medicare for the vaccines. To understand the costs of administering Vaccines, CMS has set a Payment allowance of $0.10 for both the Pfizer-BioNTech and Moderna vaccines.
CMS will update the payment allowance later when organizations start to incur costs for the vaccine products. For the vaccines' administration, the payment allowances are currently $16.94 for the first dose of a vaccine and $28.39 for the second dose. CMS notes that these rates. Medicare will reimburse Vaccines requiring a single dose at a rate of $28.39.
The Provider Relief fund provides reimbursements for administering the COVID-19 vaccine for uninsured patients. According to the provider relief fund website, they will generally be reimbursed at Medicare rates, subject to available funding.
Billing for Vaccine Administration
To bill Medicare for COVID-19 vaccine administration, providers need to be enrolled in Medicare. Providers can submit a single claim or adopt a roster billing for multiple patients (Minimum 5 patients).
For institutional claims, specifically, 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
82X, Hospice (Hospital)
34X, Home Health (Part B Only)
72X, Independent and Hospital-based Renal Dialysis Facility
75X, Comprehensive Outpatient Rehabilitation Facility
81X, Hospice (Non-hospital)
85X, Critical Access Hospital
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