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Updates to COVID-19 vaccine administration codes and pharmaceutical treatment
January 15, 2021

ATTENTION: Some of this information has been updated in an article published at a later date. Please consult the latest News & Updates on our COVID-19 information page

This article is for all providers caring for our members

Blue Cross Blue Shield of Massachusetts follows federal and state-mandated requirements for COVID-19 treatment coverage.

For our commercial products (managed care HMO and POS, PPO, and Indemnity), we will accept the following CPT codes for COVID vaccines and COVID vaccine administration. For Medicare Advantage plans, you must submit claims for COVID-19 vaccine and the administration of the vaccine to the CMS Medicare Administrative Contractor (MAC) for payment.

Please submit the vaccine administration procedure code and vaccine/toxoid code on the same claim. Since the vaccine is supplied free, we will not reimburse separately for the vaccine, regardless of the modifier.

If a vaccine administration service is provided with an Evaluation and Management service that:

  • Is appended with modifier 25 and is unrelated to the vaccine administration service, Blue Cross will reimburse both services.
  • Is not appended with modifier 25 or appended with modifier 25 and is related to vaccine administration service, Blue Cross will deny the evaluation and management service.

This applies to professional and facility claims.

Vaccine and vaccine administration codes for COVID-19

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, we 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

DOSE #1: 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

DOSE #2: 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, we 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

DOSE #1: 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

DOSE #2: Bill for administration of second dose of CPT 91301 (Moderna-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 emergency use authorization or approval from the FDA, Blue Cross will accept this vaccine CPT code and administrative codes for the ‘AstraZeneca’ vaccine and vaccine administration.

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

FDA-approved pharmaceutical treatment for COVID-19 infection

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 Medicare Advantage members, coverage is through original Medicare.

For our commercial products (managed care HMO and POS, PPO, and Indemnity), we will accept the following CPT codes for treatment for COVID-19 infection.  For Medicare Advantage plans, you must submit claims for COVID-19 drug and the administration of the drug to the CMS Medicare Administrative Contractor (MAC) for payment.

We are following guidelines from the Blue Cross Blue Shield Association regarding coverage for Federal Employee Program members. For more details please visit fepblue.org.

Since the drug is supplied free, we will not reimburse separately for the drug regardless of modifier.

Code Service description Comments
Q0239 Injection, bamlanivimab-xxxx, 700 mg Effective 11/9/2020
Drug code not reimbursed regardless of modifier
M0239 Intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoring Effective 11/9/2020
Q0243 Injection, casirivimab and imdevimab, 2400 mg Effective 11/21/2020
Drug code not reimbursed regardless of modifier
M0243 Intravenous infusion, casirivimab and imdevimab includes infusion and post administration monitoring Effective 11/21/2020

Resources

Professional and Hospital fee schedule updates
The following temporary COVID-19 Professional fee schedules have been updated on Provider Central:

For information regarding Hospital outpatient fee schedule updates, please contact your network representative.