COVID Vaccines Begin Rollout as Medicare Announces Coverage

Moderna’s vaccine is expected to be shipped to providers nationwide, on the heels of Pfizer’s.

A reeling nation couldn’t have asked for a better Christmas present.

The Food and Drug Administration (FDA) issued an Emergency Use Authorization (EUA) for the Pfizer-BioNTech COVID-19 vaccine for individuals 16 and older last week – a development expected to be repeated for Moderna’s vaccine this week, with others still to follow – as the initial doses began being shipped to healthcare facilities nationwide amid the soaring heights of a nearly yearlong global viral pandemic that has hit the United States disproportionately hard.

Both vaccines have been estimated at approximately 94-95 percent effectiveness, surpassing expectations and offering a glimmer of hope at the end of a rough year.

The Centers for Medicare & Medicaid Services (CMS) issued a MLN Connects Special Edition advisory on Monday, noting that Medicare will cover and pay for the administration of any vaccine furnished consistent with the EUA. The advisory also directed providers to only bill for the vaccine administration codes when submitting claims to Medicare; providers should not include the vaccine product codes when the vaccines are free of charge.

“Today’s announcement is a historic turning point in the fight against the virus – the beginning of the end of this chapter in our world’s history has arrived,” CMS Administrator Seema Verma said in a statement issued shortly after Pfizer’s EUA approval. “Our hearts and minds continue to be with those who have lost loved ones, and I urge states to prioritize nursing homes and vulnerable seniors in their distribution of the vaccine. As we approach more widespread distribution, all Americans can take comfort in the fact that CMS has laid the groundwork to guarantee that every American can get the vaccine for free.”

The COVID-19 pandemic has resulted in nearly 75 million cases and 1.6 million deaths worldwide, with the U.S. alone accounting for nearly 17 million cases and more than 300,000 deaths. New cases that numbered about 50,000 daily during the initial stages of the pandemic, domestically, have soared to more than 200,000 during the last two weeks.

To view a Pfizer fact sheet regarding the administration of its vaccine, go online to: https://www.fda.gov/media/144413/download

To view CMS’s updated payment and HCPCS Level I CPT code structure for vaccine information, go to: https://www.cms.gov/medicare/medicare-part-b-drug-average-sales-price/covid-19-vaccines-and-monoclonal-antibodies

To view CMS’s FAQs page on Medicare FFS billing, go to: https://www.cms.gov/files/document/03092020-covid-19-faqs-508.pdf

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Mark Spivey

Mark Spivey is a national correspondent for RACmonitor.com, ICD10monitor.com, and Auditor Monitor who has been writing and editing material about the federal oversight of American healthcare for more than a decade.

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