Has CMS provided guidance on how to bill for 3rd doses of COVID-19 vaccines for immunocompromised patients?
Yes. On August 16, 2021, CMS published the MLN Connects Special Edition bulletin linked below, where they outline the administration CPT codes and payment rates for 3rd doses of Pfizer and Moderna COVID-19 vaccines. Per CMS, report CPT 0003A when administering the 3rd dose of the Pfizer vaccine, and report CPT 0013A when administering a 3rd dose of the Moderna vaccine. We have provided the long descriptors for both codes below.
0003A: Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3 mL dosage, diluent reconstituted; third dose
0013A: Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5 mL dosage; third dose
As noted in the MLN Connects, both 0003A and 0013A will be made retroactively effective back to August 12, 2021 – the date the FDA amended the Emergency Use Authorization (EUA) for the Pfizer and Moderna vaccines to allow 3rd doses for immunocompromised individuals. Per the FDA news release noted below, the agency is approving 3rd doses of COVID-19 vaccines for “certain” immunocompromised patients; “specifically, solid organ transplant recipients or those who are diagnosed with conditions that are considered to have an equivalent level of immunocompromise.” The agency states it will provide additional clinical recommendations regarding immunocompromised patients at a later date.
With regards to payment, CMS states it will reimburse 3rd dose COVID-19 vaccine administration codes at the same rate as first and second doses; approximately $40.00.
Within the MLN Connects, CMS acknowledges they will need time to update their backend systems to be able to process claims with these new codes. Therefore, CMS states it will be holding claims that contain charges for 0003A and 0013A until the necessary updates are completed. CMS states the updates will be completed no later than August 27, 2021.
CMS MLN Connects Special Edition, “COVID-19 Vaccines Additional Doses: Codes & Payment”:
FDA News Release, “Coronavirus (COVID-19) Update: FDA Authorizes Additional Vaccine Dose for Certain Immunocompromised Individuals”: