COVID-19 Vaccine Guidance

Last update: February 20, 2021, 1:00 p.m. CT

Keeping you up to date on the latest developments for a COVID-19 vaccine is our top priority. We’re closely monitoring COVID-19 vaccine updates from state and federal governments and health care agencies. We will continue to post on this page as new information becomes available. 

Click here for more information from the U.S. Food and Drug Administration (FDA) on emergency use authorization (EUA) of the COVID-19 vaccine.

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. 

Reminder: You should not bill UnitedHealthcare members at the time of service for any costs associated with the COVID-19 vaccine. Learn more below.

The cost of COVID-19 FDA-authorized vaccine serums will initially be paid for by the U.S. government.

UnitedHealthcare will reimburse CDC COVID-19 vaccination program providers for the administration of FDA-authorized and U.S. government provided COVID-19 vaccines. Reimbursement will be made in accordance with applicable state laws and federal provisions, including the CARES Act and FDA guidance, as outlined below. 

Reminder: You should not bill UnitedHealthcare members at the time of service for any costs associated with the COVID-19 vaccine. Claims for vaccine administration should be submitted as outlined, based on the member’s benefit plan. There is no cost to the member for the COVID-19 vaccine, and most plans are covering the administration of the COVID-19 vaccine at no cost share for the member.

Updates and additional information will be posted on this site as quickly as possible when new information is available.

  • Medicare Advantage health plans: Charges for COVID-19 vaccine administration for all Medicare beneficiaries should be billed to the Center for Medicare & Medicaid Services (CMS) Medicare Administrative Contractor (MAC). The MAC will reimburse claims for Medicare beneficiaries with no cost share (copayment, coinsurance or deductible) for the remainder of 2020 and through 2021. For more information, visit the CMS COVID-19 Insurers Toolkit.
    • Any COVID-19 vaccine-related claims for Medicare beneficiaries that are submitted to UnitedHealthcare will be denied, and health care professionals will be directed to submit the claims to the MAC.
  • Medicare ID lookup: When billing to the MAC, you will need to include the members Medicare Beneficiary Identifier (Medicare ID) number which is different than the member’s assigned UnitedHealthcare member ID number. Follow our step-by-step guide to learn how to look up a member’s Medicare ID number in the UnitedHealthcare Provider Portal. 
  • Employer and Individual health plans, including Student Resources, short term limited liability (STLD) and Exchange plans: UnitedHealthcare and self-funded customers covers the administration of COVID-19 FDA-authorized vaccines with no cost share for in- and out-of-network providers, during the national public health emergency period. Administration fees for in-network providers will be based on contracted rates. Administration fees for out-of-network providers will be based on CMS published rates.
  • Medicaid: Medicaid state-specific requirements may apply. For Medicaid and other state-specific regulations, please refer to your state-specific website or your state’s UnitedHealthcare Community Plan website, if applicable. UnitedHealthcare will pay administration fees at CMS published rates unless otherwise specified.

In-Office Visits

  • For Employer and Individual health plans, UnitedHealthcare will reimburse for the vaccine administration at no cost share (copayment, coinsurance or deductible) for the member. Charges for the office visit and other services rendered during the visit will be adjudicated according to the member’s benefit plan.
  • For Medicare Advantage plans, if a member has a scheduled office visit with a health care professional and the COVID-19 vaccine is administered during that visit, the claim will need to be billed in two parts:
    • The MAC should be billed for the vaccine administration.
    • UnitedHealthcare should be billed for the office visit. 

Standard benefits and claims processing guidelines will apply.

Reminder: You should not bill UnitedHealthcare members at the time of service for any costs associated with the COVID-19 vaccine. Claims for vaccine administration should be submitted as outlined, based on the member’s benefit plan. There is no cost to the member for the COVID-19 vaccine, and most plans are covering the administration of the COVID-19 vaccine at no cost share for the member.

Administration and claims submission

Health plan

Medical

Pharmacy

Medicare Advantage

Bill claims to the applicable CMS Medicare Administrative Contractor (MAC)

 

Bill claims to the applicable CMS Medicare Administrative Contractor (MAC)

Employer and Individual health plans, including Student Resources, short-term limited liability (STLD) and Exchange plans

UnitedHealthcare and self-funded customers cover the administration of COVID-19 FDA-authorized vaccines with no cost share for in- and out-of-network providers during the national public health emergency period, currently scheduled to end April 20, 2021. Administration fees for in-network providers will be based on contracted rates. Administration fees for out-of-network providers will be based on CMS published rates.

 

Pharmacies will be allowed to bill UnitedHealthcare directly for the costs associated with the administration of COVID-19 vaccines. Pharmacists administering the COVID-19 vaccine serum provided by the federal government should submit claims through their pharmacy claims platform.

Medicaid

Participating providers may bill the UnitedHealthcare medical benefit through our standard claims process. Pharmacist should submit their claims through their pharmacy platform. Reimbursement for vaccine services will be based on the provider’s contract rate. State Medicaid agencies may provide different guidance.

Pharmacies will be allowed to bill UnitedHealthcare directly for the costs associated with the administration of COVID-19 vaccines. Pharmacists administering the COVID-19 vaccine serum provided by the federal government should submit claims through their pharmacy claims platform.

Members can review more information about the vaccine at the COVID-19 Vaccine Member Center.

The COVID-19 vaccine serum will initially be paid by the U.S. government.

Eligible members receiving the vaccine will not have any out-of-pocket costs (copayment, coinsurance or deductible), whether for the vaccine or the vaccine administration, when the U.S. government provides the vaccine. Health care professionals should not bill members for these claims. Reminder: At the time of service, you should not ask UnitedHealthcare members for payment of any costs associated with the COVID-19 vaccine.

For Individual and Group Market* health plans, UnitedHealthcare and self-funded customers will be required to cover the administration of COVID-19 vaccines with no cost share (copayment, coinsurance or deductible) for in- and out-of-network providers, during the national public health emergency period. Administration fees for in-network providers will be based on contracted rates. Administration fees for out-of-network providers will be based on CMS published rates.

*Does not apply to short-term duration health plans

Due to limited supply, FDA-authorized COVID-19 vaccine distribution is being coordinated by the CDC and state and local health departments. The federal government is also working to help accelerate vaccination and provide resources to help end the pandemic.

Vaccination is occurring in phases, with those at highest risk getting vaccines first. Health care workers, residents of long-term care facilities, essential workers and people age 65 and older may be eligible to get the vaccine, as local supplies allow. 

COVID-19 Vaccine Resource Locator

Members and health care professionals can use our zip-code-based Vaccine Resource Locator tool to find FDA-authorized COVID-19 vaccine resources near them. We've gathered links to public resources to help members stay informed. These public resources may include: who can get a vaccine, where to get a vaccine, how to sign up for alerts and how to schedule an appointment.

COVID-19 vaccine availability is changing quickly. UnitedHealthcare is actively monitoring updates from the federal government, Centers for Disease Control and Prevention (CDC), U.S. Food & Drug Administration (FDA) and Centers for Medicare & Medicaid Services (CMS), as well as state and local public health departments.

UnitedHealthcare aligns with America Medical Association (AMA) CPT® coding for medical claims. Health care professionals should use published AMA CPT codes when submitting COVID-19 vaccine administration claims to UnitedHealthcare under the member’s medical benefit.

Currently Approved AMA CPT Codes:

Manufacturer

Vaccine Dose CPT

National Drug Code

1st Administration CPT

2nd Administration CPT

Pfizer

91300

59267-1000-1

0001A

0002A

Moderna

91301

80777-273-10

0011A

0012A


Additional codes will be added as they become available.

Codes will be added to all applicable provider fee schedules as part of the standard quarterly code update and any negotiated discounts and premiums will apply to these codes. Codes will be added using the CMS published effective date for the codes and payment allowance as the primary fees source.

Modifiers

Modifiers are not required when submitting COVID-19 vaccine administration claims through the member’s medical benefit.

CPT® is a registered trademark of the American Medical Association.

We’re listening.

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. 


Disclaimer:

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.