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COVID-19 Vaccine and Administration Billing

1/12/2021

For Commercial these codes may be billed for as "reporting only", with $0.00, $0.01 or $0.02.  For Medicaid these codes are able to be billed for ‘reporting only’ as well and would need to be billed with $0.01. PacificSource will reimburse solely for the administration of the vaccine.  For Medicare, the vaccine and administration codes must be billed to Traditional Medicare for reimbursement.  Please refer to the chart below for the appropriate administration code of the vaccine provided.

Vaccine Code Vaccine Code Descriptor Vaccine Administration Code(s) Vaccine Manufacturer Vaccine Name(s) NDC 10/NDC 11 Labeler Product ID (Vial) Dosing Interval
91300 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, for intramuscular use

0001A (1st dose)

0002A (2nd dose)

Pfizer, Inc

Pfizer-BioNTech COVID-19 Vaccine

59267-1000-1

59267-1000-01

21 days
91301
  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, diluent reconstituted, for intramuscular use

0011A (1st dose)

0012A (2nd dose)

Moderna, Inc

Moderna COVID-19 Vaccine

80777-273-10

80777-0273-10

28 days
91302 Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, chimpanzee adenivirus Oxford 1 (ChAdOx1) vector, preservative free, 5x10 viral particles/0.5mL dosage, for intramuscular use

0021A (1st dose)

0022A (2nd dose)

AstraZeneca, Plc AstraZeneca COVID-19 Vaccine

0310-1222-10

00310-1222-10

28 days

 


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