Provider Notice Issued 04/08/2021

Page Content

Page Content

Date:     April 8. 2021

 

To:       Enrolled Hospitals:  Chief ExecutiveOfficers; Chief Financial Officers; and Patient Accounts Managers

 

Re:      COVID-19 Vaccine Administration Performed in Hospital-BasedOutpatient Settings

 

 

This notice informs hospitals of theappropriate process for billing COVID-19 vaccine administration performed inhospital-based outpatient settings. The billing direction applies to claims forpersons covered under both traditional fee-for-service and a HealthChoice Illinois managed care plan. 

 

As an exception to current hospitaloutpatient billing policy, the Department will reimburse COVID-19 vaccineadministration in hospital-based outpatient settings via the 837 Professional claimformat. While any qualified practitioner can administer the vaccine, hospitals mustuse the Medical Director, Chief Medical Officer, or other authorizedpractitioner name and NPI as the Rendering Provider in NM1, Rendering ProviderName, Loop 2310B, on the 837P claim. This authorized practitioner must be registeredin IMPACT. Thebilling information in NMI, Billing Provider Name, Loop 2010AA must be linkedto the Rendering Provider Name and NPI.   

 

Institutionalclaims for vaccine administration that have already been submitted and paid shouldbe voided and the service rebilled through the professional claim format. 

 

Thechart below identifies the current coding and rate structure for vaccineadministration. Hospitals are encouraged to refer to the COVID-19 Updates webpagefor the most up-to-date COVID-19 provider information, including updatedCOVID-19 fee schedules.

 

Procedure Code	Effective Date	Description	Effective for Claims with DOS on or after 03/15/2021
91300	12/11/2020	Pfizer-Biontech COVID-19 Vaccine	N/A (currently government-supplied at no cost to the provider)
0001A	12/11/2020	Pfizer-Biontech COVID-19 Vaccine Administration – First Dose	$16.94
0001A	3/15/2021	Pfizer-Biontech COVID-19 Vaccine Administration – First Dose	$42.14
0002A	12/11/2020	Pfizer-Biontech COVID-19 Vaccine Administration – Second Dose	$28.39
0002A	3/15/2021	Pfizer-Biontech COVID-19 Vaccine Administration – Second Dose	$42.14
91301	12/18/2020	Moderna COVID-19 Vaccine	N/A (currently government-supplied at no cost to the provider)

0011A	12/18/2020	Moderna COVID-19 Vaccine Administration – First Dose	$16.94
0011A	3/15/2021	Moderna COVID-19 Vaccine Administration – First Dose	$42.14
0012A	12/18/2020	Moderna COVID-19 Vaccine Administration – Second Dose	$ 28.39
0012A	3/15/2021	Moderna COVID-19 Vaccine Administration – Second Dose	$42.14
91303	02/27/2021	Janssen Covid-19 Vaccine	N/A (currently government-supplied at no cost to the provider)
0031A	02/27/2021	Janssen Covid-19 Vaccine Administration	$28.39
0031A	03/15/2021	Janssen Covid-19 Vaccine Administration