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Ask a Rev Cycle Expert: CPT® 0031A Reimbursement?

Question:

Is there reimbursement information for CPT® code 0031A IMM ADMN SARSCOV2 AD26 5X1010 VP/0.5 ML 1 DOSE?

Answer:

Because the Janssen Pharmaceutical (parent company: Johnson & Johnson) vaccine is a single dose, the Centers for Medicare & Medicaid Services (CMS) has indicated the reimbursement rate of $28.390 on their COVID-19 Vaccines and Monoclonal Antibodies page, with an effective date of February 27, 2021. The rate has yet to be posted in the Addendum A & B pricing files, but we are in the process of adding the information to the Code Lookup module.

https://www.cms.gov/medicare/medicare-part-b-drug-average-sales-price/covid-19-vaccines-and-monoclonal-antibodies

Disclaimer: This information was current at the time of its publishing and is designed to provide accurate information in regard to the subject matter covered. Vitalware does not accept any responsibility or liability with regard to any errors, omissions, misuses, or misinterpretation by the reader. It is not intended to take the place of either the written policies or regulations. We encourage you to review the specific regulations and other interpretive materials as necessary. All CPT® codes are trademarked by the American Medical Association (AMA) and all revenue codes are copyrighted by the American Hospital Association (AHA).