NEW UPDATED GUIDANCE – COVID-19 Vaccine & Antibody Therapy Coding

AIMA COVID-19 Vaccine Medical Codes Update

VACCINE LATEST – Here at AIMA, the medical coding team make it our priority to stay 100% informed with the latest medical coding changes, rules and regulations. We ensure consistent first-time, clean billing claims for maximized reimbursement with optimized revenue cycle management services.

Read on to find to save you hours of research and potential coding errors. We have drawn together the latest guidance on coronavirus COVID-19 vaccine and antibody therapy coding for US-based physician practices, laboratories and surgical centers. The purpose of this article is to highlight the most up-to-date information on:

  1. Toolkit on COVID-19 Vaccine: Health Insurance Issuers & Medicare Advantage Plans – Updated January 2021 by CMS
  2. New codes for coronavirus COVID-19 vaccine  – Current Procedural Terminology (CPT) codes updates published by the American Medical Association (AMA)
  3. New codes for COVID-19 antibody therapy – published by Centers for Disease Controls and Prevention (CDS)

New codes for coronavirus COVID-19 vaccine  

The America Medical Association (AMA) has published an update to the Current Procedural Terminology (CPT®) code set that includes new vaccine-specific codes to report immunizations for the new coronavirus, SARS-CoV-2.

CPT codes have been created for reporting of immunizations for the novel coronavirus (SARS-CoV-2, also known as COVID-19). These CPT codes are unique for each coronavirus vaccine as well as administration codes unique to each such vaccine. The new CPT codes clinically distinguish each coronavirus vaccine for better tracking, reporting and analysis that supports data-driven planning and allocation.

Among these is a new code to describe the additional supplies and clinical staff time required to mitigate transmission of respiratory infectious disease while providing evaluation, treatment or procedural services during a public health emergency.

For quick reference, the new Category I CPT codes and long descriptors for the vaccine products are:

  • 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.
  • 91301: 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.

The new vaccine administration CPT codes and long descriptions are:

  • 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
  • 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

The release says these new vaccine-specific CPT codes will be available for use and effective upon each new COVID-19 vaccine which receives emergency use authorization or approval from the Food and Drug Administration. See the AMA website for further information.

New codes for COVID 19 antibody therapy

The Centers for Medicare & Medicaid Services (CMS) recently published an interim final rule with comment period (IFC) to implement Section 3713 of the Coronavirus Aid, Relief, and Economic Security Act (CARES Act), which established Medicare Part B coverage and payment for COVID-19 vaccine and administration.

A new investigational monoclonal antibody therapy for Medicare patients with mild to moderate COVID-19 warrants new codes. The Centers for Medicare & Medicaid Services (CMS) announced Dec. 3, 2020, that it is implementing two new HCPCS Level II codes for Regeneron’s antibody casirivimab and imdevimab (REGN-COV2), effective for dates of service on or after Nov. 21.

How To Report Regeneron’s Antibody Therapy

CMS created the new codes in response to the U.S. Food and Drug Administration (FDA) issuing an emergency use authorization (EUA) for the new therapy on Nov. 9. The two drugs are administered together, and the therapy is reported with the following new HCPCS Level II codes:

HCPCS codeDescriptionPayment
Q0243Injection, casirivimab and imdevimab, 2400 mg$0.01
M0243Intravenous infusion, casirivimab and imdevimab includes infusion and post administration monitoring$309.60

Providers can bill under Medicare Part B for the administration of this infusion therapy on a single claim or submit multiple claims on a roster bill. CMS warns, however, that the requirements for administration of this therapy are “considerably more complex” and may not lend themselves to roster billing.

Providers should make sure to document the steps they took to meet the terms of the FDA’s EUA. CMS also wants to see the name of the practitioner who ordered or made the decision to administer the infusion to each patient, even if using roster billing.

Reimbursement for REGN-COV2 and Admin

The Medicare national average payment rate of approximately $310 for the monoclonal antibody administration is based on one hour of infusion and post-administration monitoring in the hospital outpatient setting. Medicare will adjust the payment allowance for M0243 based on geographic location and setting, as appropriate.

Providers should not bill Q0243 if they received the product for free. CMS says it will adjust the payment allowance if providers begin to purchase the products, and “anticipate addressing coding and payment rates for administration of monoclonal antibody products through future notice and comment rulemaking.”

The ability for entities other than a skilled nursing facility (SNF) to submit claims for monoclonal antibody products and their administration furnished to Medicare Part A SNF residents is limited to an enforcement discretion notice activated by CMS in regards to SNF consolidated billing.

Appropriate Use of Regeneron’s REGN-COV2

This therapy is deemed appropriate for adults and pediatric patients (12 years and older, weighing at least 88.2 pounds) who test positive for COVID-19 and are at high risk for developing severe COVID-19 that may require hospitalization. The therapy must be administered in a setting in which healthcare providers have immediate access to medications to treat severe infusion reactions and the ability to activate the Emergency Medical System, as necessary.

Casirivimab and imdevimab are not authorized for use in patients with COVID-19 who are hospitalized, require oxygen therapy, or require an increase in baseline oxygen flow rate.

Other Covered COVID-19 Therapies

Last month, CMS created codes for another COVID-19 monoclonal antibody product and its administration. Effective Nov. 10, report Eli Lilly’s antibody bamlanivimab (LY-CoV555) therapy with Q0239 Injection, bamlanivimab-xxxx, 700 mg and M0239 Intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoring. The payment allowances and billing requirements for these codes are the same as for Q0243 and M0243.

For more detailed information about our medical coding and billing services, please contact the AIMA team today. We are here to help and support US-based physician practices, laboratories and surgical centers with expert revenue cycle management solutions.

REFERENCES & RESOURCES  

https://www.medicaleconomics.com/view/coronavirus-ama-releases-vaccine-cpt-codes

https://www.aapc.com/blog/52407-how-to-report-regenerons-regn-cov2/