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Participating Hospital Covid-19 Reimbursement

Effective for Dates of Service beginning January 1, 2021

This guide provides information for Independent Health’s participating hospitals on reimbursement rates for the following COVID-19-related services.

Commercial, Self-Funded, & State Products

  • Cost of vaccine doses: The cost of the vaccine doses currently being dispensed under federal and state vaccination plans is being funded by the federal government so the health plan will not reimburse for the doses. Independent Health will deny claims submitted for the dose for invoice in preparation for when they are no longer obtained at no cost.
  • Administration components: In most circumstances Independent Health will reimburse for the administration components of the vaccination until otherwise directed by the federal government or New York State.
Medicare Advantage
  • Medicare Fee-for-Service is paying for the vaccine and administration components for all Medicare beneficiaries, including those enrolled in Medicare Advantage plans, through calendar year 2021.
  • Providers must submit claims to their applicable Medicare Administrative Contractor (MAC) (National Government Services in Western New York) for reimbursement.

Reimbursement Rates

The below reimbursement rates are effective for vaccines which have obtained FDA Emergency Use Authorization (EUA). Visit the CMS site for a comprehensive list of vaccine products, codes and effective dates as the FDA approves them.

Dates of Service January 1, 2021 – March 14, 2021

Description
Service Code
Vaccine Effective Date
Commercial & Self-Funded
State Products

Pfizer Admin 1

0001A

12/11/2020

$15.50

$13.23

Pfizer Admin 2

0002A

12/11/2020

$25.50

$13.23

Moderna Admin 1

0011A

12/18/2020

$15.50

$13.23

Moderna Admin 2

0012A

12/18/2020

$25.50

$13.23

Janssen Admin 1

0031A

02/27/2021

$25.50

$13.23

Dates of Service March 15, 2021 – Current

Description
Service Code
Vaccine Effective Date
Commercial & Self-Funded
State Products

Pfizer Admin 1

0001A

12/11/2020

$40.00

$13.23

Pfizer Admin 2

0002A

12/11/2020

$40.00

$13.23

Moderna Admin 1

0011A

12/18/2020

$40.00

$13.23

Moderna Admin 2

0012A

12/18/2020

$40.00

$13.23

Janssen Admin 1

0031A

02/27/2021

$40.00

$13.23

Coverage Grid

This grid indicates instances when Covid-19 vaccine administration services are separately payable.

Place of Service
Commercial & Self-Funded
Medicare Advantage
State Products

Inpatient Hospital

Global

Bill Medicare

Payable*

ER/Observation

Global

Bill Medicare

Global

Part A Skilled Nursing

Payable*

Bill Medicare

Payable*

Dialysis

Global

Bill Medicare

Global

Home Health

Global

Bill Medicare

Payable*

*Hospitals and skilled nursing facilities should include the coding for the vaccine administration directly on the inpatient claim.

Additional Notes

  • Independent Health will be editing claims to ensure providers are not billing for more than one initial or subsequent administration.
  • The administration for the vaccine doses does not need to be completed by the same provider. In the event that a member receives a second vaccine administration from a different provider than their first dose the claim will pay.