In previous Medicaid COVID-19 special bulletins #154, #173 and #177, providers were instructed to bill Revenue Code 0261 with vaccine and monoclonal antibody administration codes in combination with the HCPCS code to support the appropriate drug administration.
To allow claims to process at CMS approved rates, providers should bill with Revenue Code 0771 instead of Revenue Code 0261 on future claims for the vaccine and monoclonal antibody administration services below.
Providers with claims that processed and paid with Revenue Code 0261 have an option to void their original claim and submit a claim with Revenue Code 0771 in order to receive reimbursement at 100% of the NC Medicaid Fee Schedule or wait for reprocessing, which will be addressed in a future announcement.
Procedure Codes |
Vaccine/Procedure Name |
Effective date |
End Date |
0001A |
Pfizer-BioNTech COVID-19 Vaccine Administration – First Dose |
12/11/2020 |
12/31/9999 |
0002A |
Pfizer-BioNTech COVID-19 Vaccine Administration – Second Dose |
12/11/2020 |
12/31/9999 |
0003A |
Pfizer-BioNTech COVID-19 Vaccine Administration – Third Dose |
8/12/2021 |
12/31/9999 |
0004A |
Pfizer-BioNTech COVID-19 Vaccine Administration – Booster |
9/22/2021 |
12/31/9999 |
0011A |
Moderna COVID-19 Vaccine Administration – First Dose |
12/11/2020 |
12/31/9999 |
0012A |
Moderna COVID-19 Vaccine Administration – Second Dose |
12/11/2020 |
12/31/9999 |
0013A |
Moderna COVID-19 Vaccine Administration – Third Dose |
8/12/2021 |
12/31/9999 |
0031A |
Janssen (Johnson & Johnson) COVID-19 Vaccine Administration - First Dose |
2/27/2021 |
12/31/9999 |
0034A |
Janssen (Johnson & Johnson) COVID-19 Vaccine Administration - Booster |
10/20/2021 |
12/31/9999 |
0064A |
Moderna COVID-19 Vaccine (Low Dose) Administration - Booster |
10/20/2021 |
12/31/9999 |
0071A |
Pfizer-BioNTech COVID-19 Pediatric Vaccine - Administration - First dose |
10/29/2021 |
12/31/9999 |
0072A |
Pfizer-BioNTech COVID-19 Pediatric Vaccine - Administration - Second dose |
10/29/2021 |
12/31/9999 |
M0201 |
COVID-19 vaccine administration inside a patient's home; reported only once per individual home per date of service when only COVID-19 vaccine administration is performed at the patient's home |
6/8/2021 |
12/31/9999 |
M0239 |
Intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoring |
11/10/2020 |
4/16/2021 |
M0240 |
Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring, subsequent repeat doses |
7/30/2021 |
12/31/9999 |
M0241 |
Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring in the home or residence, this includes a beneficiary's home that has been made provider-based to the hospital during the COVID-19 public health emergency, subsequent repeat doses |
7/30/2021 |
12/31/9999 |
M0243 |
Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring |
11/21/2020 |
12/31/9999 |
M0244 |
Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring in the home or residence; this includes a beneficiary’s home that has been made provider-based to the hospital during the COVID-19 public health emergency |
5/6/2021 |
12/31/9999 |
M0245 |
Intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring |
2/9/2021 |
12/31/9999 |
M0246 |
Intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring in the home or residence; this includes a beneficiary’s home that has been made provider-based to the hospital during the COVID-19 public health emergency |
5/6/2021 |
8/27/2021 |
M0247 |
Intravenous infusion, sotrovimab, includes infusion and post administration monitoring |
5/26/2021 |
12/31/9999 |
M0248 |
Intravenous infusion, sotrovimab, includes infusion and post administration monitoring in the home or residence; this includes a beneficiary’s home that has been made provider-based to the hospital during the COVID-19 public health emergency |
5/26/2021 |
12/31/9999 |
M0249 |
Intravenous infusion, tocilizumab, for hospitalized adults and pediatric patients (age 2 and older) with COVID-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) only, includes infusion and post administration monitoring, first dose |
6/24/2021 |
12/31/9999 |
M0250 |
Intravenous infusion, tocilizumab, for hospitalized adults and pediatric patients (age 2 and older) with COVID-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) only, includes infusion and post administration monitoring, second dose |
6/24/2021 |
12/31/9999 |
CONTACT
NCTracks Contact Center: 800-688-6696