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NC Medicaid »   Home »   blog

SPECIAL BULLETIN COVID-19 #208: Amended Outpatient Billing Guidance for Vaccine and Monoclonal Antibody Administration Providers should bill with revenue code 0771 instead of 0261

January 6, 2022

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

 

This blog is related to:

  • Bulletins
  • All Providers
  • COVID-19

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https://medicaid.ncdhhs.gov/blog/2022/01/06/special-bulletin-covid-19-208-amended-outpatient-billing-guidance-vaccine-and-monoclonal-antibody