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.
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 |
We have added two new HCPCS codes to our temporary COVID-19 payment policy for monoclonal antibody treatment for COVID-19 infections:
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.
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:
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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