COVID-19 Updates

Please keep the following COVID-19 policies and procedures in mind:

  • Prior Authorization Update for MA Commercial Products: For Massachusetts Commercial products, in accordance with the Nov. 17 Massachusetts Division of Insurance Bulletin 2021-15, and until further notice, Harvard Pilgrim is waiving prior authorization requirements for any scheduled surgeries and admissions at acute care facilities, mental health hospitals, and post-acute care facilities. These facilities are expected to notify carriers about any inpatient admissions within 24 hours of a patient being admitted and provide updates at a minimum of every five days to support discharge planning. For complete details on prior authorization requirements for these and other products, please refer to our COVID-19 Provider Information and Resources page.
  • Medicare Advantage Plans Coverage of COVID-19 Vaccine: Through the end of 2021, the Centers for Medicare & Medicaid Services reimburses providers for the COVID-19 vaccine and its administration, with providers submitting claims to the appropriate CMS Medicare Administrative Contractor (MAC) for payment. However, beginning Jan. 1, 2022, providers should bill Medicare Advantage plans for the vaccine and its administration.
  • COVID-19 Vaccine for Children Ages 5-11: On Nov. 2, the Centers for Disease Control announced that the Pfizer-BioNTech pediatric COVID-19 vaccine is recommended for children ages 5 to 11. For billing purposes, please use the following CPT codes:
    • 91307: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 10 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation, for intramuscular use
    • 0071A: Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 10 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation; first dose
    • Second dose, 0072A: Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 10 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation; second dose

For additional coding guidance, please refer to the COVID-19 Testing and Treatment Coding Grid.


Publication Information

Audrey Kleinberg,
Director, Provider Relations & Communications

Annmarie Dadoly,
Editor

Joseph O’Riordan,
Writer

Kristin Edmonston,
Production Coordinator