COVID-19 vaccine billing and reimbursement
COVID-19 vaccines are available to our members with no out-of-pocket costs*. Providers should not collect any member cost share, such as copays, for first or second doses of COVID-19 vaccines or administration of the vaccine.
The vaccine is currently being distributed at no cost to providers. You may bill for the administration of both the first and second dose of the vaccine using the following guidelines, which vary depending on your patient's plan type.
For Medicare members
In 2020 and 2021, Medicare payment for the COVID-19 vaccine and its administration will be made through the original fee-for-service Medicare program. Submit claims for administering the COVID-19 vaccine to Medicare members to the CMS Medicare Administrative Contractor (MAC).
If you submit a claim to Priority Health for a Medicare member's COVID-19 vaccine administration, the claim will deny with instruction to bill CMS directly.
See CMS's codes and reimbursement.
For Medicaid members
Reimbursement for COVID-19 vaccine administration will be 100% of Medicare rates. Following state guidelines, you should bill the vaccine service with a billed amount of $0 plus the administrative service on the claim. We'll reimburse for the administrative fee.
FQHCs, RHCs, THCs and Tribal FQHCs may be reimbursed for COVID-19 vaccine administration when no other eligible qualifying clinic visit is provided on the same date of service.
Vaccine CPT codes to bill at $0 for Medicaid members
- 91300 (Pfizer vaccine) 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
- 91301 (Moderna vaccine) 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
See MDHHS's COVID-19 and vaccine information.
For commercial group and individual members
The COVID-19 vaccine will be added to our Preventive Care Guidelines, which means most members will have $0 cost share. Some grandfathered plans—a plan that has not changed since 2010— or commercial retiree plans that are not subject to the Affordable Care Act may have member costs.
Submit claims for the administration of the vaccine to Priority Health using the codes listed below.
COVID-19 vaccine billable codes and reimbursement rates
The following administration codes are billable to Priority Health for Medicaid and commercial members:
Pfizer vaccine administration codes
| Medicare | Commercial | Medicaid | |
|---|---|---|---|
|
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 |
Submit claims to the CMS Medicare Administrative Contractor (MAC) | $16.94 | $16.94 |
| 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 | Submit claims to the CMS Medicare Administrative Contractor (MAC) | $28.39 | $28.39 |
Moderna vaccine administration codes
| Medicare | Commercial | Medicaid | |
|---|---|---|---|
| 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 | Submit claims to the CMS Medicare Administrative Contractor (MAC) | $16.94 | $16.94 |
|
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 |
Submit claims to the CMS Medicare Administrative Contractor (MAC) | $28.39 | $28.39 |
*Some grandfathered commercial plans, which are plans that haven't changed since 2010, or commercial retiree plans that are not subject to the Affordable Care Act may have member costs.