New Janssen vaccine and vaccine administration codes for COVID‑19
FDA Emergency Use Authorization was granted for Johnson & Johnson’s Janssen vaccine to be administered for COVID‑19.
We have added the following two new CPT codes for the Janssen vaccine and vaccine administration to our temporary COVID-19 payment policy. See details in the table below.
- 91303 - Janssen COVID-19 vaccine
- 0031A - Janssen COVID-19 vaccine administration
COVID-19 vaccine and administration codes we cover
Here is the full list of COVID-19 vaccines and vaccine administration codes that we cover. Since the vaccines are supplied free, we do not reimburse separately for the vaccine, regardless of modifier.
| Code | Service description | Comments |
|---|---|---|
| 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 |
Effective 12/11/2020 (Pfizer-BioNtech COVID-19 vaccine) Since the vaccine is supplied free, Blue Cross will not reimburse separately for the vaccine, regardless of the modifier. |
| 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 |
Effective 12/11/2020 Bill for administration of first dose of CPT 91300 (Pfizer-BioNtech COVID-19 vaccine) |
| 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 |
Effective 12/11/2020 Bill for administration of second dose of CPT 91300 (Pfizer-BioNTech COVID-19 vaccine) |
| 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 |
Effective 12/18/2020 (Moderna-COVID-19 vaccine) Since the vaccine is supplied free, Blue Cross will not reimburse separately for the vaccine, regardless of the modifier. |
| 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 |
Effective 12/18/2020 Bill for administration of first dose of CPT 91301 (Moderna-COVID-19 vaccine) |
| 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 |
Effective 12/18/2020 Bill for administration of second dose of CPT 91301 (Moderna-COVID-19 vaccine) |
| 91303 | Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, adenovirus type 26 (Ad26) vector, preservative free, 5x1010 viral particles/0.5mL dosage, for intramuscular use |
Effective 2/27/2021 (Janssen COVID-19 vaccine) Since the vaccine is supplied free, Blue Cross will not reimburse separately for the vaccine, regardless of the modifier. |
| 0031A |
Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, adenovirus type 26 (Ad26) vector, preservative free, 5x1010 |
Effective 2/27/2021 Bill for administration of CPT 91303 (Janssen COVID-19 vaccine) |
| 91302 | Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, chimpanzee adenovirus Oxford 1 (ChAdOx1) vector, preservative free, 5x1010 viral particles/0.5mL dosage, for intramuscular use |
Once a COVID-19 vaccine has EUA or approval from the FDA, Blue Cross will accept this vaccine CPT code and administrative codes. (91302 AstraZeneca-COVID-19 vaccine) Since the vaccine is supplied free, we will not reimburse separately for the vaccine, regardless of the modifier. |
| 0021A | Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, chimpanzee adenovirus Oxford 1 (ChAdOx1) vector, preservative free, 5x1010 viral particles/0.5mL dosage; first dose | |
| 0022A | Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, chimpanzee adenovirus Oxford 1 (ChAdOx1) vector, preservative free, 5x1010 viral particles/0.5mL dosage; second dose |
Update to pharmaceutical treatment codes for COVID-19
We have added two new HCPCS codes to our temporary COVID-19 payment policy for monoclonal antibody treatment for COVID-19 infections:
- Q0245 injection, bamlanivimab and etesevimab, 2100 mg
- M0245 intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring
FDA Emergency Use Authorization was granted for bamlanivimab and etesevimab to be administered together for the treatment of mild to moderate COVID-19 in adults and pediatric patients (12 years of age and older weighing at least 40 kg) with positive results of direct SARS-CoV-2 viral testing. The treatment is for those at high risk for progressing to severe COVID-19 or hospitalization.
Here is the full list of pharmaceutical treatments that we cover. Since the drugs are supplied free, we do not reimburse separately for the drug, regardless of modifier.
| Code | Service description | Comments |
|---|---|---|
| M0239 | Intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoring |
Effective 11/9/2020 |
| M0243 | Intravenous infusion, casirivimab and imdevimab includes infusion and post administration monitoring |
Effective 11/21/2020 |
| M0245 | Intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring |
Effective 2/9/2021 |
| Q0239 | Injection, bamlanivimab-xxxx, 700 mg |
Effective 11/9/2020 Drug code not reimbursed regardless of modifier |
| Q0243 | Injection, casirivimab and imdevimab, 2400 mg |
Effective 11/21/2020 Drug code not reimbursed regardless of modifier |
| Q0245 | Injection, bamlanivimab and etesevimab, 2100 mg |
Effective 2/9/2021 Drug code not reimbursed regardless of modifier |
As a reminder, Blue Cross Blue Shield of Massachusetts covers all FDA-approved drugs for COVID-19 with no cost share to our members throughout the duration of the public health emergency.
- For our commercial products (managed care HMO and POS, PPO, and Indemnity), we will accept the HCPCS codes on the table above for treatment for COVID-19 infection.
- For our Medicare Advantage members, coverage is through original Medicare. You must submit claims for the COVID-19 vaccine, pharmaceutical treatment, and the administration of the drug to the CMS Medicare Administrative Contractor (MAC) for payment.
- For our Federal Employee Program members, we are following guidelines from the Blue Cross Blue Shield Association. For more details, please visit fepblue.org.
Resources
COVID-19 Temporary payment policy
Professional and Hospital Fee schedule updates
The following temporary COVID-19 professional fee schedules have been updated on Provider Central:
- Temporary COVID-19 Professional Commercial and FEP Fee Schedule During COVID-19 Public Health Emergency (Effective 9/1/20)
- Temporary COVID-19 Professional Medicare Advantage Fee Schedule During COVID-19 Public Health Emergency (2021 Fee Schedule, effective 1/1/21)
To download these fee schedules, log in and go to Office Resources>Billing & Reimbursement>Fee Schedules.
Acute care hospital fee schedule updates
For information on COVID-19 temporary hospital outpatient fee schedule updates, please contact your network representative.
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