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 AMA’s website 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.
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.
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 would be provided through the Original Medicare program. This includes charges for the vaccine and its administration. All claims for administering the COVID-19 vaccine to Humana MA members during 2020 and 2021 should be submitted to the Medicare Administrative Contractors. Humana will deny any vaccine product or administration claims received for MA members for dates of service in 2020 and 2021. Claims for administering the COVID-19 vaccine to Humana MA members for dates of service beginning January 1, 2022, should be submitted to Humana.
Please refer to Humana’s COVID-19 Vaccine claims payment policy 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 Humana’s COVID-19 Related Coding claims payment policy for further information regarding billing expectations. This policy outlines the following:
- COVID-19 Related Diagnosis Coding
- COVID-19 Vaccine 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.