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The Centers for Medicare and Medicaid (CMS) Release Billing Guidelines for COVID-19 Vaccine

WellCare of Kentucky is closely following advancements in the prevention and treatment of COVID-19, including vaccinations. As a healthcare provider, you will play an integral role as COVID-19 vaccines become available. We want to update you on important new information about vaccine coverage.

To prepare for vaccine administration, the Centers for Medicare and Medicaid (CMS) have published billing guidance for Medicaid and Children’s Health Insurance Program (CHIP) providers. Similar to other COVID-19 services, the vaccines will be offered at no cost to your patients. In addition:

• WellCare will configure its systems to properly adjudicate COVID-19 vaccine-related claims, for vaccine administration, in accordance with Kentucky’s coverage determinations for Medicaid beneficiaries
• Member liability will be $0
• Non-participating provider pre-auth requirements will be waived

The American Medical Association (AMA) has published updates to the Current Procedural Terminology (CPT®) code set that includes new vaccine-specific codes to report immunizations for the novel coronavirus (SARS-CoV-2). The code set will continue to be updated as additional vaccines receive EUA approval by the U.S. Food & Drug Administration (FDA).

The following codes and reimbursement rates have been published by DMS as of December 14, 2020. However, they will not be billable until the specific vaccine receives official EUA approval.

WellCare of Kentucky will expect providers to follow these billing guidelines when they submit claims to WellCare.  WellCare is defining the reimbursement rate listed below as equating to 100% of the Medicaid Fee Schedule.  Providers’ contractual reimbursement rates will be applied accordingly to determine a provider’s reimbursement.

Additionally, CMS has also published a set of toolkits to help providers prepare to swiftly administer the vaccine once it is available. If you have any further questions about this upcoming vaccine or the COVID-19 services WellCare covers, please contact Provider Services at (877) 389-9457.