Guidelines for COVID-19 vaccines and monoclonal antibodies Billing
The patient can get the vaccines including of booster dose and or additional doses.
The patient administered the vaccine with no out of pocket cost for both vaccines and administration of the vaccines.
Vaccinate everyone, including the uninsured, regardless of coverage or network status.
When COVID-19 vaccine and monoclonal antibody doses are provided by the government without charge, only bill for the vaccine administration. Don't include the vaccine codes on the claim when the vaccines are free.
If the patient is enrolled in a Medicare Advantage (MA) plan, submit your COVID-19 vaccine and monoclonal antibody infusion claims to Original Medicare in 2020 and 2021. On or after January 1, 2022, claims for vaccine or mAb administrations for Medicare Advantage enrolls should be submitted to the Medicare Advantage plan.
For services provided to Medicare Advantage enrolls on or after January 1, 2022, contact the Medicare Advantage for guidance on coverage and billing.
Code Description Vaccine Name Effective date
91300* SARSCOV2 VAC 30MCG/0.3ML IM Pfizer 12/11/2020
0001A ADM SARSCOV2 30MCG/0.3ML 1ST Pfizer 12/11/2020
0002A ADM SARSCOV2 30MCG/0.3ML 2ND Pfizer 12/11/2020
0003A ADM SARSCOV2 30MCG/0.3ML 3RD Pfizer 08/12/2021
0004A ADM SARSCOV2 30MCG/0.3ML BST Pfizer 09/22/2021
91301* SARSCOV2 VAC 100MCG/0.5ML IM Moderna 12/18/2020
0011A ADM SARSCOV2 100MCG/0.5ML1ST Moderna 12/18/2020
0012A ADM SARSCOV2 100MCG/0.5ML2ND Moderna 12/18/2020
0013A ADM SARSCOV2 100MCG/0.5ML3RD Moderna 08/12/2021
91303* SARSCOV2 VAC AD26 .5ML IM Janssen 02/27/2021
0031A ADM SARSCOV2 VAC AD26 .5ML Janssen 02/27/2021
0034A ADM SARSCOV2 VAC AD26 .5ML B Janssen 10/20/2021
91305* SARSCOV2 VAC 30 MCG TRS-SUCR Pfizer 01/03/2022
0051A ADM SARSCV2 30MCG TRS-SUCR 1 Pfizer 01/03/2022
0052A ADM SARSCV2 30MCG TRS-SUCR 2 Pfizer 01/03/2022
0053A ADM SARSCV2 30MCG TRS-SUCR 3 Pfizer 01/03/2022
0054A ADM SARSCV2 30MCG TRS-SUCR B Pfizer 01/03/2022
91306* SARSCOV2 VAC 50MCG/0.25ML IM Moderna 10/20/2021
0064A ADM SARSCOV2 50MCG/0.25MLBST Moderna 10/20/2021
91307* SARSCOV2 VAC 10 MCG TRS-SUCR Pfizer 10/29/2021
0071A ADM SARSCV2 10MCG TRS-SUCR 1 Pfizer 10/29/2021
0072A ADM SARSCV2 10MCG TRS-SUCR 2 Pfizer 10/29/2021
0073A ADM SARSCV2 10MCG TRS-SUCR 3 Pfizer 01/03/2022
M0201** COVID-19 vaccine home admin N/A 06/08/2021
**Providers should not bill for the product if they received it for free.
**The services are covered only in places of service 04, 06, 09, 12, 13, 14, 16, 19, 22, 33, 54, 55, 56, and 60
Monoclonal antibodies and administration
Code Description Effective date
Q0220* Tixagev and cilgav, 300mg 12/08/2021
Q0221* Tixagev and cilgav, 600mg 02/24/2022
M0220 Tixagev and cilgav inj 12/08/2021
M0221 Tixagev and cilgav inj hm 12/08/2021
Q0222* Bebtelovimab 175 mg 02/11/2022
M0222 Bebtelovimab injection 02/11/2022
M0223 Bebtelovimab injection home 02/11/2022
Q0239* bamlanivimab-xxxx 11/10/2020 – 04/16/2021
M0239 bamlanivimab-xxxx infusion 11/10/2020 – 04/16/2021
Q0240* Casirivi and imdevi 600mg 07/30/2021
M0240 Casiri and imdev repeat 07/30/2021
M0241 Casiri and imdev repeat hm 07/30/2021
Q0243* casirivimab and imdevimab 11/21/2020
M0243 Casirivi and imdevi inj 11/21/2020
Q0244* casirivi and imdevi 1200 mg 06/03/2021
M0244 Casirivi and imdevi inj hm 05/06/2021
Q0245* bamlanivimab and etesevima 02/09/2021
M0245 bamlan and etesev infusion 02/09/2021
M0246 bamlan and etesev infus home 05/06/2021
Q0247** sotrovimab 05/26/2021
M0247 sotrovimab infusion 05/26/2021
M0248 sotrovimab inf, home admin 05/26/2021
Q0249** Tocilizumab for COVID-19 06/24/2021
M0249 Adm Tocilizu COVID-19 1st 06/24/2021
M0250 Adm Tocilizu COVID-19 2nd 06/24/2021
Note:
- *Providers should not bill for the product if they received it for free.
- **The government won’t provide this drug for free.
