Medical Coding Guideline for COVID Patients
With COVID-19 vaccinations being distributed throughout the United States, we have compiled this list of Medical Coding Guideline code sets to account for the treatment and vaccinations for the Covid patients.
For getting reimbursed for the administration of the vaccine, the use of the right medical code is necessary. Since the providers received the vaccines free from the government, they cannot bill for the vaccines.
Since April 2020, the Centers for Medicare and Medicaid Services (CMS) has formulated over 20 ICD-10-PCS codes for documenting COVID-19 vaccines and treatments.
However, for hospitalized patients, CMS pays for the COVID-19 vaccine and its application individually out of the Diagnosis-Related Group rate. To reimburse for administering the vaccine to Medicare beneficiaries, the hospital should use the right CPT codes.
The American Medical Association (AMA) has already published CPT codes for reporting the vaccine of COVID-19.
For getting reimbursed, Medical Coding Guideline is important for the providers so that they can use the right medical codes for the administration of vaccines and medicine. CMS states that it will reimburse providers under Medicare Part B, rather than Part D, to ensure broad coverage of the vaccine.
Since providers received the vaccines free from the government, they cannot bill Medicare for the vaccines. To understand the costs of administering Vaccines, CMS has set a Payment allowance to some of the companies.
The Centers for Medicare & Medicaid Services (CMS) offers an interim enrollment for facilities and providers who are not at present enrolled but would like to become a COVID-19 vaccination administrator. An abbreviated enrollment process includes a quick call to the regional Medicare Administrative Contractor.
In June 2021, CMS publicized the option for an added payment for administering the COVID-19 vaccination in-home to Medicare recipients. Medical Coding Guideline is for those who find difficulties in reaching healthcare service and are not easy to go out of homes or are hard-to-reach. Providers can bill for this service utilizing the new HCPCS code M0201 for COVID-19 vaccine administration.
If more than one patient is being vaccinated at the same in-home visit, providers should bill the HCPCS code M0201 only once and bill additional CPT product/dose codes as necessary. Billing for in-home administration should be done only once per date, per service.
In May 2021, the Department of Health and Human Services (HHS) started on the COVID-19 Coverage Assistance Fund (CAF) for covering the costs of administering COVID-19 vaccines to the enrolled patients in health plans that either do not cover vaccination fees or cover them with patient cost-sharing.
Private health insurance payers continue to update their policies regarding the Medical Coding Guideline as the COVID-19 public health crisis mutates its character. To check each payer’s most updated policy changes to the billing and coding for telehealth and COVID-19, never forget to visit the payers’ website for detailed information.