Commercial

Coverage of the COVID-19 Vaccination for AmeriHealth Members


Policy Impacted


Purpose

The purpose of this communication is to provide advance notice regarding information and procedure codes related to the coverage of SARS-CoV-2 (Coronavirus Disease 2019 (COVID-19)) vaccines and administration of the vaccines for AmeriHealth members.​

Background

There is currently an outbreak of respiratory disease caused by a novel coronavirus, which has been detected both nationally and internationally. The virus has been named “SARS-CoV-2" and the disease it causes has been named “Coronavirus Disease 2019" (COVID-19). 


Several pharmaceutical companies have developed vaccines that have shown efficacy in the prevention of  SARS-CoV-2 infection. Distribution of COVID-19 vaccine will be controlled by the U.S Government, who will collaborate with local and state governments. It is anticipated that the COVID-19 vaccine will initially be distributed to health care providers at no charge.


ACIP RECOMMENDATION

​In accordance with the December 3, 2020 interim recommendation, the Advisory Committee on Immunization Practices (ACIP) recommends that the COVID-19 vaccine be administered to healthcare personnel and residents of long-term care facilities for the initial phase of the COVID-19 vaccination program. ​


Coverage Statement


The administration of COVID-19 vaccine is eligible for reimbursement consideration as a preventive service when the U.S. Food and Drug Administration ​(FDA)​ Emergency Use Authorization (EUA) criteria for the ​COVID-19 vaccine are met. 


According to the Centers for Disease Control and Prevention (CDC), the COVID-19 vaccine will initially be distributed to health care providers at no charge. Therefore, additional reimbursement for the COVID-19 vaccine will not be provided by the Company.

 

REQUIRED DOCUMENTATION

The individual's medical record must reflect that the care provided is according to the pertinent FDA EUAs criteria and requirements. These medical records may include, but are not limited to, records from the professional providers' office, hospital, nursing home, home health agencies, therapies, and test reports.

The Company may conduct reviews and audits of services to our members, regardless of the participation status of the provider. All documentation must be made available to the Company upon request. Failure to produce the requested information may result in a denial for the service.​​


Coding


ADMINISTRATION OF COVID-19 VACCINE


0001A, 0002A, 0011A, 0012A 

 


COVID-19 VACCINE-THE VACCINE IS NOT ELIGIBLE FOR REIMBURSEMENT AS  IT WILL BE PROVIDED TO HEALTHCARE PROVIDERS AT NO CHARGE​


91300, 91301 


12/11/2020