Policy Updates Reimbursement PoliciesCommercialMay 1, 2023

Reimbursement changes to COVID-19 vaccine administration and lab services codes

During the federal Public Health Emergency (PHE) for COVID-19, new COVID-19 laboratory services and vaccine administration codes were implemented and reimbursed at rates to meet the needs of providers during the PHE. As you are aware, the federal PHE for COVID-19 expires May 11, 2023. As a result, Anthem Blue Cross and Blue Shield (Anthem) is providing notice of changes to the reimbursement of both COVID laboratory services and COVID vaccine administration. These changes will not be implemented until August 1, 2023, to help with the transition.

Effective August 1, 2023, reimbursement will be revised to Anthem's standard reimbursement methodology to align with other laboratory services and vaccine administration (for example, flu) rates for the following codes outlined below. The revised standard fee schedule for these codes will be available after August 1, 2023, either on Availity.com* or by reaching out to your Provider Relationship Management representative.

If you have any questions regarding this notice, please contact your Provider Relationship Management representative or use Availity Live Chat, which is available during normal business hours. Go to the Availity Essentials platform and select Anthem from the payer spaces drop-down. Then, select Chat with Payer and complete the pre-chat form to start your chat.

Lab Service Codes

U0001

86328

87426

87811

0224U

U0002

86408

87428

G2023

0225U

U0003

86409

87635

G2024

0226U

U0004

86413

87636

0202U

0240U

U0005

86769

87637

0223U

0241U

Vaccine Administration Codes

CPT® or HCPCS code

CPT or HCPCS short descriptor

Labeler name

Vaccine/procedure name

0001A

ADM SARSCOV2 30MCG/0.3ML 1ST

Pfizer

Pfizer-BioNTech COVID-19 vaccine administration — first dose

0002A

ADM SARSCOV2 30MCG/0.3ML 2ND

Pfizer

Pfizer-BioNTech COVID-19 vaccine administration — second dose

0003A

ADM SARSCOV2 30MCG/0.3ML 3RD

Pfizer

Pfizer-BioNTech COVID-19 vaccine administration — third dose

0004A

ADM SARSCOV2 30MCG/0.3ML BST

Pfizer

Pfizer-BioNTech COVID-19 vaccine administration — booster

0011A

ADM SARSCOV2 100MCG/0.5ML1ST

Moderna

Moderna COVID-19 vaccine administration — first dose

0012A

ADM SARSCOV2 100MCG/0.5ML2ND

Moderna

Moderna COVID-19 vaccine administration — second dose

0013A

ADM SARSCOV2 100MCG/0.5ML3RD

Moderna

Moderna COVID-19 vaccine administration — third dose

0021A

ADM SARSCOV2 5X10^10VP/.5ML 1

AstraZeneca

AstraZeneca COVID-19 vaccine administration — first dose

0022A

ADM SARSCOV2 5X10^10VP/.5ML 2

AstraZeneca

AstraZeneca COVID-19 vaccine administration — second dose

0031A

ADM SARSCOV2 VAC AD26 .5ML

Janssen

Janssen COVID-19 vaccine administration — first dose

0034A

ADM SARSCOV2 VAC AD26 .5ML B

Janssen

Janssen COVID-19 vaccine administration — Booster

0041A

ADM SARSCOV2 5MCG/0.5ML 1ST

Novavax

Novavax COVID-19 vaccine administration — first dose

0042A

ADM SARSCOV2 5MCG/0.5ML 2ND

Novavax

Novavax COVID-19 vaccine administration — second dose

0044A

ADM SARSCOV2 5MCG/0.5ML BST

Novavax

Novavax COVID-19 vaccine, adjuvanted administration — booster

0051A

ADM SARSCV2 30MCG TRS-SUCR 1

Pfizer

Pfizer-BioNTech COVID-19 vaccine (ready to use) administration — first dose

0052A

ADM SARSCV2 30MCG TRS-SUCR 2

Pfizer

Pfizer-BioNTech COVID-19 vaccine (ready to use) administration — second dose

0053A

ADM SARSCV2 30MCG TRS-SUCR 3

Pfizer

Pfizer-BioNTech COVID-19 vaccine (ready to use) administration — third dose

0054A

ADM SARSCV2 30MCG TRS-SUCR B

Pfizer

Pfizer-BioNTech COVID-19 vaccine (ready to use) administration — booster

0064A

ADM SARSCOV2 50MCG/0.25MLBST

Moderna

Moderna COVID-19 vaccine (low dose) administration — booster

0071A

ADM SARSCV2 10MCG TRS-SUCR 1

Pfizer

Pfizer-BioNTech COVID-19 pediatric vaccine administration — first dose

0072A

ADM SARSCV2 10MCG TRS-SUCR 2

Pfizer

Pfizer-BioNTech COVID-19 pediatric vaccine administration — second dose

0073A

ADM SARSCV2 10MCG TRS-SUCR 3

Pfizer

Pfizer-BioNTech COVID-19 pediatric vaccine (orange cap) administration — third dose

0074A

ADM SARSCV2 10MCG TRS-SUCR B

Pfizer

Pfizer-BioNTech COVID-19 pediatric vaccine (orange cap) administration — booster

0081A

ADM SARSCOV2 3MCG TRS-SUCR 1

Pfizer

Pfizer-BioNTech COVID-19 pediatric vaccine (aged 6 months through 4 years) (maroon cap) administration — first dose

0082A

ADM SARSCOV2 3MCG TRS-SUCR 2

Pfizer

Pfizer-BioNTech COVID-19 pediatric vaccine (aged 6 months through 4 years) (maroon cap) administration — second dose

0083A

ADM SARSCOV2 3MCG TRS-SUCR 3

Pfizer

Pfizer-BioNTech COVID-19 pediatric vaccine (aged 6 months through 4 years) (maroon cap) administration — third dose

0091A

ADM SARSCOV2 50 MCG/.5 ML1ST

Moderna

Moderna COVID-19 pediatric vaccine (aged 6 years through 11 years) (blue cap with purple border) administration — first dose

0092A

ADM SARSCOV2 50 MCG/.5 ML2ND

Moderna

Moderna COVID-19 pediatric vaccine (aged 6 years through 11 years) (blue cap with purple border) administration — second dose

0093A

ADM SARSCOV2 50 MCG/.5 ML3RD

Moderna

Moderna COVID-19 pediatric vaccine (aged 6 years through 11 years) (blue cap with purple border) administration — third dose

0094A

ADM SARSCOV2 50MCG/0.5 MLBST

Moderna

Moderna COVID-19 vaccine (aged 18 years and older) (blue cap with purple border) 50mcg/0.5ml administration — booster

0111A

ADM SARSCOV2 25MCG/0.25ML1ST

Moderna

Moderna COVID-19 pediatric vaccine (aged 6 months through 5 years) (blue cap with magenta border) administration — first dose

0112A

ADM SARSCOV2 25MCG/0.25ML2ND

Moderna

Moderna COVID-19 pediatric vaccine (aged 6 months through 5 years) (blue cap with magenta border) administration — second dose

0113A

ADM SARSCOV2 25MCG/0.25ML3RD

Moderna

Moderna COVID-19 pediatric vaccine (aged 6 months through 5 years) (blue cap with magenta border) administration — third dose

0124A

ADM SARSCV2 BVL 30MCG/.3ML B

Pfizer

Pfizer-BioNTech COVID-19 vaccine, bivalent (gray cap) administration — booster dose

0134A

ADM SARSCV2 BVL 50MCG/.5ML B

Moderna

Moderna COVID-19 vaccine, bivalent (aged 12 years and older) (dark blue cap with gray border) administration — booster dose [6]

0144A

ADM SARSCV2 BVL 25MCG/.25ML B

Moderna

Moderna COVID-19 vaccine, bivalent (aged 6 years through 11 years) (dark blue cap with gray border) administration — booster dose

0154A

ADM SARSCV2 BVL 10MCG/.2ML B

Pfizer

Pfizer-BioNTech COVID-19 vaccine, bivalent product (aged 5 years through 11 years) (orange cap) administration — booster dose

0164A

ADM SRSCV2 BVL 10MCG/0.2ML B

Moderna

Moderna COVID-19 vaccine, bivalent (aged 6 months through 5 years) (dark pink cap and label with a yellow box) administration — booster dose

0173A

ADM SARSCV2 BVL 3MCG/0.2ML 3

Pfizer

Pfizer-BioNTech COVID-19 pediatric vaccine (aged 6 months through 4 years) (maroon cap) administration — third dose

M0201

COVID-19 vaccine home admin

Home vaccine admin

COVID-19 vaccine administration inside a patient's home; reported only once per individual home per date of service when only COVID-19 vaccine administration is performed at the patient's home

* Availity, LLC is an independent company providing administrative support services on behalf of the health plan.

CTBCBS-CM-022828-23

PUBLICATIONS: May 2023 Provider News