Physicians Call for Fair Reimbursement for COVID-19 Vaccines

COVID-19 Vaccination Reimbursement

Physicians are asking for adequate reimbursement for all COVID-19 vaccines and their administration, according to a new policy statement from the American College of Physicians (ACP).

The statement released on Jan. 12 calls on health policymakers to require insurers to “provide adequate reimbursement for all vaccines, including COVID-19 vaccines, administered according to” scientific guidelines established by the Advisory Committee on Immunization Practices (ACIP).

“Private and public payers should inform care teams of all billing, coding, and other information necessary to obtain prompt reimbursement for administering the vaccine and providing related counseling and follow-up care to patients,” ACP states.

The group also made recommendations about the provision and distribution of COVID-19 vaccines, stressing the “importance of communication and collaboration among physicians and other vaccinators to ensure patient safety and continuity of care, information technology issues, and reimbursement and billing.”

Specifically, ACP recommends that policymakers allow all appropriately trained, state-licensed clinicians to administer COVID-19 vaccines, with physicians playing an advisory role to address concerns about vaccine hesitancy and post-vaccine care.

All vaccinators, including pharmacists, nurses, and healthcare professionals in retail health clinics, should also coordinate vaccinations with a patient’s primary care team, sharing appropriate immunization paperwork, referring patients to their primary care provider for counseling and follow-up, and establishing a structured referral system to primary care settings, the group added.

Vaccinators should also be required to record vaccine administration data within a patient’s medical record and send that data to the state’s immunization information systems or other designated systems.

Additionally, ACP suggests that government agencies, vaccine manufacturers, and other related stakeholders distribute all vaccine-related educational and outreach materials, quality protocols, storage and handling information, documentation, and any other vaccine requirements to vaccinators.

As a whole, the recommendations outline a coordinated strategy for COVID-19 vaccination, the ACP says.

“A vaccine can only be as effective as our ability to turn them into actual vaccinations given to our patients and the public,” according to Jacqueline W. Fincher, MD, MACP, president of ACP.  “A coordinated effort is critical to distributing the COVID-19 vaccine to the public and will require communication, collaboration and information sharing among physicians and other vaccinators.”

The Food and Drug Administration (FDA) has only approved two COVID-19 vaccines for emergency use in patients at this time. The vaccines are manufactured by either Moderna or Pfizer and BioNTech and have both been found to be over 90 percent effective at preventing coronavirus after two doses.

More emergency use authorizations are in the pipeline, however, including for the vaccine developed by Janssen, a division of Johnson & Johnson, and AstraZeneca, which teamed up with the University of Oxford to develop the vaccine. The Janssen vaccine is unique as a single-dose vaccine, but AstraZeneca’s vaccine has already been approved for emergency use in the United Kingdom and Brazil.

The American Medical Association (AMA) has created unique Current Procedural Terminology (CPT) codes for all four of the vaccines – Moderna, Pfizer-BioNTech, Janssen, and AstraZeneca – in anticipation of documentation and billing requirements after FDA approvals.

CMS will reimburse clinicians for the vaccines and their administration. Medicare will pay clinicians for shots they purchase themselves, which is unlikely to occur for some time since the government has been distributing vaccines to vaccinators for free.

Medicare payment rates for vaccine administration range from about $17 for the first dose of a two-dose vaccine to about $28 for the second dose or single-dose administration.

COVID-19 legislation also requires private payers to cover vaccine administration without cost-sharing for patients in most health plans, even if patients are vaccinated by an out-of-network provider. However, payers are free to set their own rates for vaccinator reimbursement.

Over half of people in the US have private health insurance, according to data from the Kaiser Family Foundation (KFF).

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