February 25, 2022
What is new
For dates of service on or after Dec. 8, 2021, the Food and Drug Administration (FDA) issued an Emergency Use Authorization (EUA) of the vaccine administration procedure codes M0220 and M0221 for AstraZeneca’s Evusheld COVID-19 vaccine as benefits of Medicaid for adults and pediatric individuals (12 years of age and older with weight at least 40 kg).
Vaccine procedure code Q0220 is informational only, while the vaccine is distributed to the provider free of charge.
Reimbursement
We won't reimburse for Pfizer-BioNTech COVID-19 vaccines that providers received for free. Providers should not charge members for the vaccine. We will reimburse for the administration of the vaccine. Other medically necessary treatments for COVID-19 will be covered consistent with the terms of the member's benefit plan. You can also reference the CMS Medicaid toolkit for more details.
Claims Reprocessing
Claims with procedure codes M0220 and M0221 with dates of service on or after December 8, 2021, have until March 25, 2022 to reprocess claims for appropriate payment. Blue Cross and Blue Shield of Texas (BCBSTX) does not require providers to submit an appeal unless they are denied for other reasons after the claims reprocessing is complete.
Vaccine Administration claims submission information:
Vaccine Code |
Use |
Description |
M0220 |
Admin (Setting: Healthcare) |
Injection, tixagevimab and cilgavimab, for the pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available covid-19 vaccine is not recommended due to a history of severe adverse reaction to a covid-19 vaccine(s) and/or covid-19 vaccine component(s)—includes injection and post-administration monitoring |
M0221 |
Admin (Setting: Home or residence) |
Injection, tixagevimab and cilgavimab, for the pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available covid-19 vaccine is not recommended due to a history of severe adverse reaction to a covid-19 vaccine(s) and/or covid-19 vaccine component(s)—includes 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 |
Q2002 |
Information Only |
Injection, tixagevimab and cilgavimab, for the pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available covid-19 vaccine is not recommended due to a history of severe adverse reaction to a covid-19 vaccine(s) and/or covid-19 vaccine component(s)—300 mg |
Z20.822 |
Diagnosis Code |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections) |
M0220 is a benefit for the following Providers and Places of Service (POS):
- Nursing Home: Physician, Clinic/Group Practice
- Office: Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist, Physician, Physician Groups, Clinic/Group Practice
- Outpatient Hospital: Hospitals
M0221 is a benefit for the following Providers and Places of Service (POS):
- Home: Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist, Physician, Home Health Agency, CCP Provider, Clinic/Group Practice
Resources
Providers interested in enrolling as a COVID-19 vaccinator.
CMS Medicaid Toolkit - Coverage and Reimbursement of COVID-19 Vaccines, Vaccine Administration and Cost Sharing under Medicaid, the Children’s Health Insurance Program, and Basic Health Program
Questions
Providers, for questions or additional information, please:
- Contact your BCBSTX Medicaid Network team at 1-855-212-1615 or
- Submit via email Texas Medicaid Network Department
The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment. References to other third-party sources or organizations are not a representation, warranty or endorsement of such organization. Any questions regarding those organizations should be addressed to them directly. The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider.