Questions will be added regularly. Last updated 2/16/21.
Send questions to imevaccinebilling@dhs.state.ia.us
Refer to Informational Letter (IL) No. 2207-MC-FFS-CVD for more details regarding Medicaid billing guidance for the COVID-19 vaccine and monoclonal antibodies.
If the only service the patient is receiving is the vaccine administration, because there is no face-to-face visit with the Rural Health Clinic (RHC)/Federally Qualified Health Center (FQHC) provider this service not reimbursable, so would we file the cost report?
If there is not a billable face-to-face encounter and the member is Medicaid only, there is nothing billable. The costs for the vaccine administration would be included, as reimbursable costs, on the annual cost report and will be part of the cost settlement. As instructed in IL 2214, if the patient has Medicare or another payor resource, the vaccine administration fee should be filled to that resource.
If the vaccine administration is the only service provided, and can be billed separately (outside of the encounter rate), would you expect to see Place of Service (POS) code 11 or 72 on the claim?
If there is not a billable face-to-face encounter and the member is Medicaid only, there is nothing billable. The costs for the vaccine administration would be included, as reimbursable costs, on the annual cost report and will be part of the cost settlement.
We normally include the NDC number on the vaccine code, but it is mentioned in the IL that you want to see the NDC number on the administration code so that leads me to believe you only want to see the admin code and not the zero dollar vaccine, correct?
IME needs to see both the NDC number and the administration code. Both codes have to be present for the claim to process.
If NDC is on the admin code would you expect to see this in the same loop we normally send the NDC number?
The NDC should come from the vaccine packaging. The NDC should be on the vaccine line of the claim.
When billing for COVID-19 administration, do you want to see both the zero dollar vaccine (91300) and the administration code (0011A) on the claim, or just the administration code?
Both the vaccine code and the administration code need to be on the claim form and the NDC will apply to the vaccine code.
In a provider bulletin it shows $0.00 for the 91301 under column 24F charges. Is there a preference from Iowa Total Care (ITC) as to what that charge amount is? Do you want a $0.01, $0.00 or another amount? Can you please clarify what you expect to see for the 91301 & 91302 as far as a charge amount?
At this time, there is no charge for the vaccine as it is being acquired and distributed by the federal government. Providers should bill the vaccine code with submitted charges of $0.00 (zero dollars).
Does the vaccine CPT code with a $0 amount need to be on the claim along with the administration CPT?
The vaccine code and the vaccine administration code must be billed together on separate lines on the same claim.