COVID-19 Treatment and Vaccinations Medical Coding Guidelines
COVID-19 Coding Guidelines
It is imperative for medical providers to stay up-to-date on coding and billing guidelines in order to deliver safe, efficient treatments. In this blog post, we will discuss the COVID-19 treatment and vaccinations medical coding guidelines.
COVID-19 ICD-10 Codes
COVID-19 has its own ICD-10-CM code called “U07.1 COVID-19, created by the World Health Organization. These codes were approved by the Centers for Disease Control and Prevention (CDC) in March of 2020. The rule went into effect on April 1, 2020.
The Centers for Medicare and Medicaid Services (CMS) has built over 20 ICD-10-PCS codes for recording COVID-19 treatments and vaccines, which have been in use since April 2020. Six of these codes pertain to vaccination, and they are as follows:
| XW023T6 | Introduction of COVID-19 vaccine dose two into muscle, percutaneous approach, new technology group 6 |
| XW013S6 | Introduction of COVID-19 vaccine dose one into the subcutaneous tissue, percutaneous approach, new technology group 6 |
| XW013T6 | Introduction of COVID-19 vaccine dose two into the subcutaneous tissue, percutaneous approach, new technology group 6 |
| XW013U6 | Introduction of COVID-19 vaccine into the subcutaneous tissue, percutaneous approach, new technology group 6 |
| XW023S6 | Introduction of COVID-19 vaccine dose one into muscle, percutaneous approach, new technology group 6 |
| XW023U6 | Introduction of COVID-19 vaccine into muscle, percutaneous approach, new technology group 6 |
"Describe the introduction or infusion of therapeutics, including monoclonal antibodies and vaccines for COVID-19 therapy," CMS says of the latest PCS codes. Vaccines that require two doses, such as those from Pfizer and BioNTech, are also included in the codes.
However, Medicare will pay for the COVID-19 vaccine and its administration separately from the Diagnosis-Related Group rate for hospitalized patients. The hospital must use the correct CPT codes in order to be reimbursed for delivering the vaccine to Medicare beneficiaries.
COVID-19 CPT Codes
These CPT codes, as well as administration codes specific to the coronavirus vaccine, are all unique. The new CPT codes differentiate each coronavirus vaccine clinically, allowing for improved monitoring, reporting, and interpretation, as well as data-driven planning and allocation. Here are the CPT codes for reporting COVID-19 vaccines, published by the American Medical Association (AMA):
| Vaccine | Emergency Use Authorization | Code for the First Dose | Code for the Second Dose |
| Pfizer-BioNTech vaccine | Approved | 0001A | 0002A |
| Moderna | In review | 0011A | 0012A |
Vaccine Administration Reimbursement
To be reimbursed, providers must use the proper medical codes when administering vaccines. CMS says it would reimburse providers under Medicare Part B rather than Part D to ensure universal vaccine coverage. Insurers are unable to charge Medicare for the vaccines since they were given free by the government. To better understand the costs of prescribing vaccines, CMS has set a Payment Allowance of $0.10 for both the Pfizer-BioNTech and Moderna vaccines.
When organizations begin to incur expenses for vaccine supplies, CMS will amend the payment allocation. The payment allowances for vaccine administration are usually $16.94 for the first dose and $28.39 for the second dose. The Centers for Medicare and Medicaid Services (CMS) points out that these are the prices Vaccines that need only one dose would be reimbursed at a rate of $28.39 by Medicare.
The Provider Relief fund provides reimbursements for administering the COVID-19 vaccine for uninsured patients. According to the provider relief fund website, they will generally be reimbursed at Medicare rates, subject to available
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