Update on Billing COVID-19 Vaccine: CMS Issues IFC for No-Cost Coronavirus Treatment
COVID-19 vaccines that have been approved by the FDA will be covered by Medicare and most private insurers once they are available, according to CMS (2020). An Interim Final Rule with Comment Period (IFC) was released to establish that any COVID-19 vaccine that receives FDA authorization via an Emergency Use Authorization (EUA) or licensed under a Biologics License Application (BLA) will be covered at no cost to beneficiaries. Medical coders should take special note for billing COVID-19 vaccines for when they do become available.
Provisions of the CARES Act were also enacted by the IFC 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),” according to 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). An extra 65% will be paid by Medicare to cover the new COVID-19 treatments for inpatients, and Medicare will also pay separately for outpatient COVID-19 therapies.
CMS has assembled three toolkits for state Medicaid offices, providers, and health insurance plans. These toolkits, which can be accessed 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, while those requiring two or more doses will be $16.94 for the initial dose and $28.39 for the final dose (CMS, 2020). The rates will be adjusted based on geography and account for the costs to administer the vaccine.
Read the CMS announcement for additional information regarding the IFC for billing the no-cost COVID-19 vaccines (2020).
- Read our article, “CDC Releases Updated Coding & Reporting Guidelines for U07.1,” for the full coding and reporting guidelines for COVID-19 symptoms, infection, and screening tests, which are effective April 1 through September 30.
- Our previous articles, “AMA Releases Two New CPT Codes for COVID-19 Antibody Detection,” and “Selecting the Right COVID-19 Code: Should You Use CPT or HCPCS,” provide additional coding and reporting guidelines for COVID-19 laboratory tests.
- Part 1 in the “COVID-19 Explained” Series explores the Coronavirus’ history, and how to code suspected exposure to the virus.
- Part 2 dives into the ICD-10 codes for the Coronavirus symptoms and infection.
- Part 3 reviews the codes for screening for suspected COVID-19 infection.
- Read our article, “Twelve New ICD-10-PCS Hospital Procedure Codes Released for COVID-19 Treatment,” for PCS coding updates on COVID-19 treatments.
- Read our article, “Review These New CPT Codes for COVID-19 Vaccines from the AMA,” for information on how to code the impending Coronavirus vaccine once they are released to the public.
Do you want to learn the ICD-10-CM coding guidelines for COVID-19 code U07.1? Sign up for our Respiratory Diagnoses Hot Topics Webinar and find out how to code Coronavirus infections, symptoms, screening, and patient encounters. The webinar on hot coding topics provides an overview of the Official Coding Guidelines for COVID-19. See more here.