Update on Billing COVID-19 Vaccine: CMS Issues IFC for No-Cost Coronavirus Treatment

Update on Billing COVID-19 Vaccine: CMS Issues IFC for No-Cost Coronavirus Treatment

Medicare and most private insurers will cover FDA-approved COVID-19 vaccines once they are available, according to CMS (2020). An Interim Final Rule with Comment Period (IFC) was released. It established that any COVID-19 vaccine that receives FDA authorization will be covered at no cost to beneficiaries. This applies to both Emergency Use Authorization (EUA) vaccines and the vaccines licensed under a Biologics License Application (BLA). Medical coders should take special note for billing COVID-19 vaccines for when they do become available.

The IFC also enacted provisions of the CARES Act to: “ensure swift coverage of a COVID-19 vaccine by most private health insurance plans without cost-sharing from both in and out-of-network providers during the course of the public health emergency (PHE)” (CMS, 2020).

In addition, under the IFC, hospitals can receive additional payments to treat patients with these innovative new COVID-19 therapies to recoup any losses from making these treatments available, even if they do not meet the current outlier threshold of $30,000 (Modern Healthcare, 2020). Medicare will pay an extra 65% to cover the new COVID-19 treatments for inpatients. Medicare will also pay separately for outpatient COVID-19 therapies.

Furthermore, CMS has assembled three toolkits for state Medicaid offices, providers, and health insurance plans. These toolkits, which you can access here, will address concerns about billing, payments, coverage, and access.

Medicare payment rates for billing COVID-19 vaccines requiring one dose will be $28.39. Two or more doses will be $16.94 for the initial dose and $28.39 for the final dose (CMS, 2020). CMS will adjust the rates based on geography and account for the costs to administer the vaccine.

Additional Information

Read the CMS announcement for additional information regarding the IFC for billing the no-cost COVID-19 vaccines (2020).

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Do you want to learn how to apply the new 2022 ICD-10 COVID-19 codes? Sign up for our COVID-19 ICD-10 Coding Learning Path and find out how to code Coronavirus infections, symptoms, screening, post-COVID-19 condition, treatments and vaccines. The webinar provides an update to the FY2022 Official Coding Guidelines for COVID-19.

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