May 20, 2022
What is new
For dates of service on or after February 24 2022, the Centers for Medicare and Medicaid Services (CMS) added procedure code Q0221 as an informational code for the 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 Q0221 is informational only, while the vaccine is distributed to the provider free of charge.
Reimbursement
We won't reimburse for AstraZeneca’s Evusheld COVID-19 vaccine 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 February 24, 2022, will process 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:
M0220 is a benefit for the following Places of Services (POS):
- Nursing Home
- Office
- Outpatient Hospital
M0221 is a benefit for the following Places of Service (POS):
- Home
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.