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:
This applies to professional and facility claims.
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 |
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 |
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.