Change coming for Medicare Advantage COVID-19 vaccine administration claims

Beginning Jan. 1, the Centers for Medicare & Medicaid Services will require physicians and other billing clinicians to submit COVID-19 vaccine administration claims for patients covered by Medicare Advantage plans directly to the plans.

Original Medicare will no longer pay for these claims on or after this date. Until that date, though, practices should continue to follow the previous guidance, which required submitting claims to their local Medicare Administrative Contractor (MAC) when they administer COVID-19 vaccines to patients enrolled in a Medicare Advantage plan.

For additional information regarding COVID-19 vaccines:

• COVID-19 vaccination guidelines: boosters, codes, indications, and timing
• AAFP COVID-19 Booster Doses FAQ
• COVID-19 vaccines coding guide
• AMA COVID-19 Coding and Guidance

Please contact your local provider relations representative if you have questions about how to submit claims.

— Brennan Cantrell, commercial health insurance strategist, American Academy of Family Physicians

Posted on Nov. 16, 2021 by Brennan Cantrell