Providers should report charges for the vaccine product and its administration according to the Current Procedural Terminology (CPT®) coding standards established by the American Medical Association (AMA). Providers should report the code appropriate for the manufacturer-specific vaccine and dose administered. The AMA has created the codes listed in the chart below for reporting the COVID-19 vaccine. See the , opens new window for more information on COVID-19 vaccine coding.
For Humana members, all FDA-authorized COVID-19 vaccines will be covered at no additional cost during the public health emergency. Coverage applies no matter where the Humana patient gets the vaccine -- including at both in-network and out-of-network providers. It also covers instances in which two vaccine doses are required.
For Medicare Advantage (MA) members specifically, the Centers for Medicare & Medicaid Services determined that coverage for COVID-19 vaccines administered to MA plan members during 2020 and 2021 will be provided through the Original Medicare program. This includes charges for the vaccine and its administration. All claims should be submitted to the Medicare Administrative Contractors. Humana will deny any vaccine product or administration claims received for Medicare Advantage members.
For Commercial and Medicaid members, the federal government is coordinating with the states to supply all vaccine products to providers. It is not necessary for a provider to submit a vaccine product code for a state-supplied vaccine. Humana will not reimburse for a state-supplied vaccine product, however the administration of a state-supplied vaccine is reimbursable. Administration claims should be submitted to Humana using the administration codes listed above. Cost share for the administration of the vaccine will be waived.
Please refer to , opens new window for further information. Note: When the policy link is clicked, it will automatically download the claims payment policy. Due to the file size, this may take a moment to open on your computer.
For all other COVID-19 related claims, please refer to , opens new window for further information regarding billing expectations. This policy outlines the following:
- Medicare Advantage, Commercial and Medicaid Coding Policy
- COVID-19 Related Diagnosis Coding
- Modifier CS: Items and Services Related to COVID-19 Diagnostic Testing
- COVID-19 Diagnostic Test Coding
- Condition Code 51: Separate Reimbursement for Preadmission COVID-19 Diagnostic Testing
- COVID-19 Diagnostic Test Specimen Collection Coding
- COVID-19 Treatment Coding
- Additional Coding for Hospital Inpatient Claims
- Coding Related to COVID-19 PHE Waivers
Note: When the policy link above is clicked, it will automatically download the claims payment policy. Due to the file size, this may take a moment to open on your computer.