COVID-19 Vaccine and Monoclonal Antibody Billing for Home Health and Hospice Providers


This article will assist Medicare Home Health and Hospice providers with proper billing relating to COVID-19 vaccine and monoclonal antibody infusion. Beneficiary coinsurance and deductible are waived.

How to Bill for COVID-19 Vaccines and Monoclonal Antibodies
To bill single claims for COVID-19 vaccines and monoclonal antibodies, follow the instructions below:

  • For roster billing and centralized billing, reference the Medicare billing for COVID-19 vaccine shot administration page
     
  • When COVID-19 vaccine and monoclonal antibody doses are provided by the government without charge, only bill for the vaccine administration. Don't include the vaccine codes on the claim when the vaccines are free.
     
  • If the patient is enrolled in a Medicare Advantage (MA) plan, submit your COVID-19 vaccine and monoclonal antibody infusion claims to Original Medicare in 2020 and 2021

Type of Bill
The types of bill to report for the COVID-19 vaccine and monoclonal antibody infusion on the Home Health and Hospice claim form, or electronic equivalent, are:

  • 341 – Home Health Outpatient (Part B)
     
  • 81X – Hospice (non-hospital based)
     
  • 82X – Hospice (hospital based) 

COVID-19 Vaccines and Administration

Revenue Codes

  • 0771 — Preventive care services, vaccine administration. Per CMS, although there are more accurate revenue codes available for reporting of the infusions, the current guidance is for providers to utilize Revenue code 0771 to report the infusion until further instructions is issued.
     
  • 0636 — Pharmacy, drugs requiring detailed coding

Current Procedural Terminology (CPT) 
COVID-19 Vaccines and administration codes are under Payment Allowances and Effective Dates for COVID-19 Vaccines and their Administration During the Public Health Emergency.

*Providers should not bill for the product if they received it for free.

Condition Codes

  • A6 — 100 percent payment
     
  • 78 — New coverage not implemented by Medicare Advantage (billed on claims for Medicare Advantage beneficiaries only)

Diagnosis Codes

  • Z23 — Encounter for immunization. Per CMS, this code must be included when reporting an encounter for the COVID-19 vaccine or monoclonal antibody treatment.
     
  • U071 — COVID-19

Monoclonal Antibodies and Administration

Revenue Codes

  • 0771 — Preventive care services, vaccine administration. Per CMS, although there are more accurate revenue codes available for reporting of the infusions, the current guidance is for providers to utilize this code to report the infusion until further instruction is issued.
     
  • 0636 — Pharmacy, drugs requiring detailed coding

Monoclonal antibodies and administration codes are under Payment Allowances and Effective Dates for COVID-19 Monoclonal Antibodies and their Administration during the Public Health Emergency.

*Providers should not bill for the product if they received it for free.

Condition Codes

  • A6 — 100 percent payment. Per CMS, Modifier CS is not required to be reported when billing instructions are utilized, as the Part A systems have been updated to ensure there is not cost share for the patient for COVID-19 vaccines or monoclonal antibody treatments. Please note: The drug should be reported with Revenue Code 0636, and the administration/infusion should be reported with Revenue code 0771.
     
  • 78 — New coverage not implemented by Medicare Advantage (billed on claims for Medicare Advantage beneficiaries only)

Diagnosis Codes

  • Z23 — Encounter for immunization. Per CMS, this code must be included when reporting an encounter for the COVID-19 vaccine or monoclonal antibody treatment.
     
  • U071 — COVID-19

CMS will exercise such discretion:

  • During the emergency period defined in paragraph (1)(B) of section 1135(g) of the Social Security Act (42 U.S.C. § 1320b-5(g)) and ending on the last day of the calendar quarter in which the last day of such emergency period occurs; or
     
  • So long as CMS determines that there is a public health need for mass COVID-19 vaccinations in congregate care settings, whichever is later

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Last Updated: 04/21/2021