Wiki Covid vaccine reimbursement for administration - POS

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OGGPPL

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Hi, I am a new coder at a Hospital and trying to seek any advice on how to get reimbursed for the administration of Covid vaccine. We have clinics in the hospital that we give the covid vaccine at and are not getting reimbursed for administration . Denial states incorrect POS. We are billing with POS 22 as it is a clinic but located in the hospital. We even tried billing with POS 11 for Office and got denied as well. Is anyone else having this issue. We are trying to get reimbursed for the Professional portion for the administration that Medicare later stated is eligible for payment.
 
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​

How Do I Bill for Administering COVID-19 Vaccines?​

  • You must be a Medicare-enrolled provider to bill Medicare for administering COVID-19 vaccines to Medicare patients. Learn more about Enrollment for Administering COVID-19 Vaccines.
  • You can bill on single claims for administering the COVID-19 vaccine, or submit claims on a roster bill for multiple patients at a time.
  • When you choose the Place of Service (POS) code for your Part B claims, carefully consider where you provided the vaccine. Roster billers should use POS code 60 regardless of your provider type, even if you’re not a mass immunization roster biller (provider specialty type 73).
  • When the government provides COVID-19 vaccines at no cost, only bill for the vaccine administration. Don’t include the vaccine codes on the claim when the vaccines are free.
    • You must administer the vaccine with no out-of-pocket cost to your patients for the vaccine or administration of the vaccine.
    • If you want to administer the vaccine for free, you don’t have to submit a claim to Medicare, Medicaid, or another insurer. But, you can’t charge your patients or ask them to submit a claim to Medicare or another insurer.
    • If you get government funding to help pay for administering the COVID-19 vaccine (like a federal or state grant), you can still submit a claim to Medicare for administering the vaccine.
  • If you have temporary billing privileges because of the public health emergency (PHE) and you have 1 National Provider Identifier (NPI) tied to multiple Provider Transaction Access Numbers (PTANs), use the taxonomy code on your claim to help you assign the correct PTAN.
  • Use the ICD-10 diagnosis code Z23 (encounter for immunization) on the claim.
  • Until the PHE ends, you should include modifier CR on your claim only if you administer the COVID-19 vaccine at a temporary location that isn’t considered your actual practice location.
Is this going out on a UB? If so:

How to Submit Institutional Claims​

You may use roster billing format, or submit individual claims. CMS systems will accept roster bills for 1 or more patients that get the same type of shot on the same date of service.

What Are Valid Types of Bills for Roster Billing?

  • 12X, Hospital Inpatient**
  • 13X, Hospital Outpatient**
  • 22X, Skilled Nursing Facility (SNF)-covered Part A stay (paid under Part B) & Inpatient Part B
  • 23X, SNF Outpatient
  • 34X, Home Health (Part B Only)***
  • 72X, Independent and Hospital-based Renal Dialysis Facility
  • 75X, Comprehensive Outpatient Rehabilitation Facility
  • 81X, Hospice (Non-hospital)
  • 82X, Hospice (Hospital)
  • 85X, Critical Access Hospital
** For hospitalized patients, Medicare pays for the COVID-19 vaccines separately from the Diagnosis-Related Group (DRG) rate and doesn't allow billing them on 11X.

***If you’re a Medicare Advantage Plan provider, include Condition Code (CC) 78.
 
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Do either of you know about the covid screenings? We have an urgent care billing for the Rapid test and then sending the swab to our lab to run the PCR and the insurances are denying stating only one per day even though we are billing with U0003 and the urgent care is billing with U0002
 
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Pam Brooks said:


​

How Do I Bill for Administering COVID-19 Vaccines?​

  • You must be a Medicare-enrolled provider to bill Medicare for administering COVID-19 vaccines to Medicare patients. Learn more about Enrollment for Administering COVID-19 Vaccines.
  • You can bill on single claims for administering the COVID-19 vaccine, or submit claims on a roster bill for multiple patients at a time.
  • When you choose the Place of Service (POS) code for your Part B claims, carefully consider where you provided the vaccine. Roster billers should use POS code 60 regardless of your provider type, even if you’re not a mass immunization roster biller (provider specialty type 73).
  • When the government provides COVID-19 vaccines at no cost, only bill for the vaccine administration. Don’t include the vaccine codes on the claim when the vaccines are free.
    • You must administer the vaccine with no out-of-pocket cost to your patients for the vaccine or administration of the vaccine.
    • If you want to administer the vaccine for free, you don’t have to submit a claim to Medicare, Medicaid, or another insurer. But, you can’t charge your patients or ask them to submit a claim to Medicare or another insurer.
    • If you get government funding to help pay for administering the COVID-19 vaccine (like a federal or state grant), you can still submit a claim to Medicare for administering the vaccine.
  • If you have temporary billing privileges because of the public health emergency (PHE) and you have 1 National Provider Identifier (NPI) tied to multiple Provider Transaction Access Numbers (PTANs), use the taxonomy code on your claim to help you assign the correct PTAN.
  • Use the ICD-10 diagnosis code Z23 (encounter for immunization) on the claim.
  • Until the PHE ends, you should include modifier CR on your claim only if you administer the COVID-19 vaccine at a temporary location that isn’t considered your actual practice location.
Is this going out on a UB? If so:

How to Submit Institutional Claims​

You may use roster billing format, or submit individual claims. CMS systems will accept roster bills for 1 or more patients that get the same type of shot on the same date of service.

What Are Valid Types of Bills for Roster Billing?

  • 12X, Hospital Inpatient**
  • 13X, Hospital Outpatient**
  • 22X, Skilled Nursing Facility (SNF)-covered Part A stay (paid under Part B) & Inpatient Part B
  • 23X, SNF Outpatient
  • 34X, Home Health (Part B Only)***
  • 72X, Independent and Hospital-based Renal Dialysis Facility
  • 75X, Comprehensive Outpatient Rehabilitation Facility
  • 81X, Hospice (Non-hospital)
  • 82X, Hospice (Hospital)
  • 85X, Critical Access Hospital
** For hospitalized patients, Medicare pays for the COVID-19 vaccines separately from the Diagnosis-Related Group (DRG) rate and doesn't allow billing them on 11X.

***If you’re a Medicare Advantage Plan provider, include Condition Code (CC) 78.
Click to expand...
Thank you Ms. Brooks. This is very helpful.
 
0
OGGPPL said:
Thank you Ms. Brooks. This is very helpful.
Click to expand...
Pam Brooks said:


​

How Do I Bill for Administering COVID-19 Vaccines?​

  • You must be a Medicare-enrolled provider to bill Medicare for administering COVID-19 vaccines to Medicare patients. Learn more about Enrollment for Administering COVID-19 Vaccines.
  • You can bill on single claims for administering the COVID-19 vaccine, or submit claims on a roster bill for multiple patients at a time.
  • When you choose the Place of Service (POS) code for your Part B claims, carefully consider where you provided the vaccine. Roster billers should use POS code 60 regardless of your provider type, even if you’re not a mass immunization roster biller (provider specialty type 73).
  • When the government provides COVID-19 vaccines at no cost, only bill for the vaccine administration. Don’t include the vaccine codes on the claim when the vaccines are free.
    • You must administer the vaccine with no out-of-pocket cost to your patients for the vaccine or administration of the vaccine.
    • If you want to administer the vaccine for free, you don’t have to submit a claim to Medicare, Medicaid, or another insurer. But, you can’t charge your patients or ask them to submit a claim to Medicare or another insurer.
    • If you get government funding to help pay for administering the COVID-19 vaccine (like a federal or state grant), you can still submit a claim to Medicare for administering the vaccine.
  • If you have temporary billing privileges because of the public health emergency (PHE) and you have 1 National Provider Identifier (NPI) tied to multiple Provider Transaction Access Numbers (PTANs), use the taxonomy code on your claim to help you assign the correct PTAN.
  • Use the ICD-10 diagnosis code Z23 (encounter for immunization) on the claim.
  • Until the PHE ends, you should include modifier CR on your claim only if you administer the COVID-19 vaccine at a temporary location that isn’t considered your actual practice location.
Is this going out on a UB? If so:

How to Submit Institutional Claims​

You may use roster billing format, or submit individual claims. CMS systems will accept roster bills for 1 or more patients that get the same type of shot on the same date of service.

What Are Valid Types of Bills for Roster Billing?

  • 12X, Hospital Inpatient**
  • 13X, Hospital Outpatient**
  • 22X, Skilled Nursing Facility (SNF)-covered Part A stay (paid under Part B) & Inpatient Part B
  • 23X, SNF Outpatient
  • 34X, Home Health (Part B Only)***
  • 72X, Independent and Hospital-based Renal Dialysis Facility
  • 75X, Comprehensive Outpatient Rehabilitation Facility
  • 81X, Hospice (Non-hospital)
  • 82X, Hospice (Hospital)
  • 85X, Critical Access Hospital
** For hospitalized patients, Medicare pays for the COVID-19 vaccines separately from the Diagnosis-Related Group (DRG) rate and doesn't allow billing them on 11X.

***If you’re a Medicare Advantage Plan provider, include Condition Code (CC) 78.
Click to expand...
Do you know where we can find this information on administration reimbursement for Medicaid patients?
 
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