Physicians/Specialists
Facilities/Hospitals
Ancillary
Pharmacy
Publication Date: 
2020-12-10

Dec. 10, 2020, Update:  We have updated the content below to include new details on coverage for grandfathered plans. We also updated the FAQ document with information on in-network provider reimbursement. (The original article was posted on Dec. 9, 2020.)


Blue Cross Blue Shield of North Carolina (Blue Cross NC) will cover COVID-19 vaccines that are FDA approved for emergency use authorization (EUA) at no cost for all members, both during the public health emergency and after. While additional guidance may be released by the North Carolina Department of Health and Human Services (NCDHHS) later, we’re providing you with critical information that is known at this time.

Allocation and Distribution   
The vaccine will be allocated, distributed and administered to the public in phases based on availability determined by federal, state and local government authorities. Health officials have recommended, as interim guidance, that both health care personnel and residents of long-term care facilities be offered the COVID-19 vaccine in the initial phase of the vaccination program. 
 

Cost Coverage and Claims
During the public health emergency, the federal government will pay for the cost of the COVID-19 vaccine for all individuals. Additional costs associated with administering the vaccine (such as vaccine supplies, storage and provider costs) will be covered by either the federal government or the member’s health plan, depending on the member. 

Member Segment

Cost Coverage

Claims Submission Instructions

Members over 65 (Medicare and Medicare Advantage)

The federal government will pay all vaccine-related costs, with no cost to members during the public health emergency. 

 

During the public health emergency, providers should file claims related to the vaccine and administration of the vaccine directly to Traditional Medicare. 

 

If providers file vaccine-related claims with Blue Cross NC during the public health emergency, the system will deny the claim and advise the provider to file to Traditional Medicare for Medicare Advantage members.   

 

Commercial members, including non-grandfathered individual under 65 plans, small and large group (fully insured and self-funded) plans, transitional plans and student health plans

The federal government will pay for the cost of the COVID-19 vaccine. Blue Cross NC and Administrative Services Only (ASO) groups will cover vaccine administration fees during the public health emergency with no cost to members. 

Providers should submit claims to Blue Cross NC. See the table below for coding guidance.

Members on a grandfathered group plan

Vaccines will be available at no member cost-share during the public health emergency.  Blue Cross NC and Administrative Services Only (ASO) groups will cover vaccine administration fees during the public health emergency with no cost to members.  

 

Providers should submit claims to Blue Cross NC. See the table below for coding guidance.

Federal Employee Program (FEP)

Once an FDA-approved vaccine becomes available for COVID-19, all federal employee health benefit carriers are required to cover the vaccine without any member cost-sharing during the public health emergency. The FEP Operations Center is working with the FEP Director’s Office to implement this as quickly as possible once FDA-approved vaccines are available. 

 

Providers should submit claims to Blue Cross NC. See the table below for coding guidance.

 

 

 

After the public health emergency, Blue Cross NC will cover the cost of the COVID-19 vaccine with no cost-sharing to members, as part of our routine preventative care and immunization benefits in accordance with federal laws and regulations.  

 

Coding Guidance for Commercial Members
Providers should use the information below when coding for the COVID-19 vaccine.

Additionally, retail pharmacies are able to file vaccine claims under the medical or pharmacy benefits for commercial members. 

Vaccine Code  

Vaccine Code Descriptor  

Vaccine Admin Code(s)  

Vaccine Manufacturer  

Vaccine Name(s)  

Labeler Product ID  

(Vial)  

Dosing Interval  

91300  

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3mL dosage, diluent reconstituted, for intramuscular use  

0001A (1st dose)  

0002A (2nd dose)  

Pfizer, Inc  

Pfizer-BioNTech COVID-19 Vaccine  

59267-1000-1 59267-1000-01  

21 days  

91301  

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5mL dosage, for intramuscular use  

0011A (1st dose)  

0012A (2nd dose)  

Moderna, Inc  

Moderna COVID-19 Vaccine  

80777-273-10  

80777-0273-10  

28 days  

 

Out-of-Network Providers
Blue Cross NC and ASO groups will cover vaccine administration fees for out-of-network (OON) providers during the public health emergency. Current federal regulations prohibit any provider from balance billing patients for the COVID-19 vaccine. 
 

Additional Information and Resources
For more information, click here to download provider FAQs. We also encourage you to register for the Dec. 14 COVID-19 Virtual Rounds webinar where we will review this information and provide any updates.

Additionally, you can use the following resources for COVID-19 questions: