Providers that participate in the Centers for Disease Control and Prevention (CDC) COVID-19 Vaccination Program contractually agree to administer a COVID-19 vaccine regardless of an individual’s ability to pay and regardless of their coverage status, and also may not seek any reimbursement, including through balance billing, from a vaccine recipient.
All vaccines must receive Emergency Use Authorization (EUA) or approval from the U.S. Food and Drug Administration (FDA) before they can be distributed to the public.
- EUAs can be used by the FDA during public health emergencies to provide access to medical products that may be effective in preventing, diagnosing or treating a disease, provided that the FDA determines that the known and potential benefits of a product, when used to prevent, diagnose or treat the disease, outweigh the known and potential risks of the product.
- FDA-approved vaccines undergo the agency’s standard process for reviewing the quality, safety and effectiveness of medical products.
- Vaccines: Claims for COVID-19 vaccines (drugs) received at no cost to the provider do not need to be submitted to BridgeSpan. However, if required by your claim system, the vaccine can be included in the non-covered services column on the administration claim submitted to BridgeSpan.
- Administration: Providers need to submit claims to BridgeSpan for reimbursement of the administration.
- Note: Retail pharmacies can file vaccine claims under the medical or pharmacy benefits for Individual plan members.
The American Medical Association (AMA), Centers for Medicare & Medicaid Services (CMS) and the Centers for Disease Control and Prevention (CDC) collaborated to establish Current Procedural Terminology (CPT) codes and reimbursement for the COVID-19 vaccines, as well as the administration.
- Vaccines: The federal government will reimburse providers for the vaccine for all individuals based on CMS’ reimbursement rates.
- We are processing claims for the administration based on the National Relative Units (RVUs). For facility claims, we are leveraging CMS’ reimbursement rates for ambulatory payment classifications (APC) pricing in accordance with participating agreements. For claims with dates of service starting on March 15, 2021, we have adjusted pricing to align with the CMS rate increase.