UPDATE – Johnson & Johnson COVID-19 vaccine news
As of April 13, 2021, the FDA and CDC are recommending a pause in the use of the Johnson & Johnson (Janssen) COVID-19 vaccine due to a very rare and severe blood clot in some individuals who received it. Safety is a top priority for the CDC, and the use of this vaccine is on hold until these cases and analysis can be further reviewed and assessed later this week. Review this update for more information and how claims will be handled during this time.
COVID-19 billing and temporary provision updates
Last update: April 20, 2021, 11:28 p.m. CT
April 20, 2021
On April 13, 2021, the Centers for Disease Control and Prevention (CDC) and the U.S. Food and Drug Administration (FDA) issued a joint statement recommending a pause in the use of the Johnson & Johnson (Janssen) COVID-19 vaccine at federal sites, and encouraged states to follow this guidance as well.
This recommendation is in response to six cases of cerebral venous thrombosis (blood clots) and low blood platelets that have been reported out of the approximately 7 million persons in the U.S. who have received the Johnson & Johnson (Janssen) vaccine. The pause is intended to allow further investigation to understand if the incidents are vaccine related.
The CDC convened a meeting of the Advisory Committee on Immunization Practices (ACIP) to further review these cases and assess their potential significance. The FDA will review that analysis as it also investigates these cases over the next week. We will closely monitor this situation as it evolves. Please check the CDC website for updates.
Adverse Reaction instructions
Health care professionals are asked to report all COVID-19 vaccine adverse events to the Vaccine Adverse Event Reporting System.
Billing & Reimbursement information
COVID-19 vaccinations authorized for emergency use will be covered at $0 cost-share through the national public health emergency period. Additional cost and coverage details can be found in our Vaccine Billing & Reimbursement section for health care professionals. For Medicare Advantage, Individual Exchange and Individual and Fully Insured Group Market health plans, coverage and cost share for the treatment of side effects or adverse reactions from any COVID-19 vaccine will be adjudicated in accordance with a member’s benefit plan. For Medicaid plans, state requirements apply. Please refer to your state’s COVID-19-specific website for more information.
Vaccine Confidence resources
Our COVID-19 vaccine confidence section has or more information and resources to help answering patient questions regarding the COVID-19 vaccines.
New! COVID-19 Vaccine Reimbursement and Billing Overview
This course provides information on COVID-19 administration, billing, reimbursement and resources. It may be most beneficial to CDC COVID-19 vaccination program providers.
Detailed information on claim submission, coding, reimbursement and member cost share
Our Vaccine Resource Locator identifies FDA-authorized COVID-19 vaccine resources by ZIP code
Information specific to pharmacy providers, including claim submission, coding and reimbursement
We’re working with the AMA to offer resources you can use to encourage patients to wear masks
AMA, CDC and UnitedHealthcare resources to help you answer patient questions about the safety of COVID-19 vaccines
Tools and information created just for members – and you may find them useful too
We’re committed to keeping you up to date on COVID-19 – we’re monitoring your inquiries and working hard to answer your questions. Let us know how we’re doing.
We’ll be making daily updates to this site. Be sure to check back often for the latest information.
The benefits and processes described on this website apply pursuant to federal requirements and UnitedHealthcare national policy during the national emergency. Additional benefits or limitations may apply in some states and under some plans during this time.
We will adjudicate benefits in accordance with the member’s health plan.
Medicaid Providers: UnitedHealthcare will reimburse out-of-network providers for COVID-19 testing-related visits and COVID-19 related treatment or services according to the rates outlined in the Medicaid Fee Schedule.