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COVID-19 vaccine and monoclonal antibody billing for Part B providers

This article will assist Medicare Part B providers with proper billing relating to Coronavirus (COVID-19) vaccine and monoclonal antibody (mAb) infusion. Beneficiary coinsurance and deductible are waived.

How to bill for COVID-19 vaccines and monoclonal antibodies

For billing single claims for COVID-19 vaccines and monoclonal antibodies, follow the instructions below.

  • For roster billing and centralized billing refer to the Medicare billing for COVID-19 vaccine shot administration page.
  • Effective for dates of services on and after January 1, 2022, COVID-19 vaccines and mAbs provided to patients enrolled in a Medicare Advantage plan are to be billed to the Medicare Advantage plan.

For coding, effective dates and payment allowances for COVID-19 vaccines, refer to the CMS vaccine pricing – COVID-19 vaccines and monoclonal antibodies. 

Claim submission example:

  • Claim should include the proper billing of the ICD-10, Z23, in item 21 or the EDI equivalent:
  • Report the proper date of service
  • Report the proper place of service
  • Use the applicable CPT or HCPCs code
  • The diagnosis pointer should be used to indicate the primary diagnosis on the claim form
  • Report the charge amount for each line item

Image of the CMS 1500 claim with billing instructions for COVID vaccines.

HCPCS M0201 (administration of pneumococcal, influenza, hepatitis b, and/or covid-19 vaccine inside a patient's home) can be billed if it meets the criteria outlined in the following CMS resources:

Monoclonal antibodies and administrations currently authorized

For payment allowances and coding refer to the CMS vaccine pricing - COVID-19 vaccines and monoclonal antibodies and the CMS COVID-19 monoclonal antibodies webpages.

Claim submission example

  • Claim should include the proper billing of the ICD-10 in item 21 or the EDI equivalent
  • Use appropriate diagnosis coded to highest level of specificity:
  • U071 - use as appropriate.
  • Report the proper date of service
  • Report the proper place of service
  • Use the appropriate administration CPT or HCPCs code
  • The diagnosis pointer should be used to indicate the primary diagnosis on the claim form
  • Report the charge amount for each line item
Image of the CMS 1500 claim with billing instructions for monoclonal antibodies.

References