Last update: November 9, 2021, 10:30 a.m. CT
Please follow the instructions below for submitting COVID-19 vaccine administration claims, based on the member’s health plan.
Please follow the instructions below for submitting COVID-19 vaccine administration claims, based on the member’s health plan.
Health plan |
Medical |
Pharmacy |
Medicare Advantage |
Please note: For services rendered through Dec. 31, 2021, bill claims for COVID-19 vaccine administration to the applicable Centers for Medicare & Medicaid Services (CMS) Medicare Administrative Contractor (MAC). Effective Jan. 1, 2022, health care professionals administering the COVID-19 vaccine serum provided by the federal government should submit medical claims through our standard claims process. Note: + In-office visits: If a member has a scheduled office visit with a health care professional and the COVID-19 vaccine is administered during that visit, , charges for the office visit and other services rendered during the visit should be submitted through our standard claims process. Benefits will be adjudicated according to the member’s health plan. |
Please note: For services rendered through Dec. 31, 2021, bill claims for COVID-19 vaccine administration to the applicable Centers for Medicare & Medicaid Services (CMS) Medicare Administrative Contractor (MAC).
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Employer and Individual health plans, including Student Resources, short-term limited liability (STLD) and Exchange plans |
Health care professionals administering the COVID-19 vaccine serum provided by the federal government should submit medical claims through our standard claims process. UnitedHealthcare will pay an administrative fee to the health care professional that covers the vaccine administration and the member’s observation with no cost share. In-Office Visits: If a member has a scheduled office visit with a health care professional and the COVID-19 vaccine is administered during that visit, charges for the office visit and other services rendered during the visit should be submitted through our standard claims process. Benefits will be adjudicated according to the member’s health plan. |
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 health care professionals may bill the UnitedHealthcare medical benefit through our standard claims process. |
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. |
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.
UnitedHealthcare aligns with American 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.
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 and payment allowance as the primary fee’s source.
Modifiers are not required when submitting COVID-19 vaccine administration claims.
Currently Approved AMA CPT Codes
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.
Health plan |
Reimbursement Information |
Medicare Advantage |
For services rendered on or before Dec. 31, 2021, administration fees for Medicare plans will be covered by Medicare Fee-for-Service (FFS) and be reimbursed according to CMS published rates for both in-network and out-of-network providers. For services rendered Jan. 1, 2022, or later that are reimbursed through our standard claims process, 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. |
Employer and Individual health plans, including Student Resources, short-term limited liability (STLD) and Exchange plans |
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. These reimbursement rates apply unless otherwise specified by state regulations. 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. Recently, we have received questions about COVID-19 vaccine reimbursement rates for our in-network providers. Consistent with their contracts, we have been using the CMS $40 reimbursement value as the basis to pay providers since July 1. We understand the concern and see how vaccination administration during a global pandemic carries more of a cost to providers. Therefore, we will adjust claims paid less than $40 between March 15 and June 30, 2021, to reimburse at $40 per administration. The rate changes are in progress and claims will be adjusted in the upcoming weeks. Providers do not need to take any action for these adjustments to be processed. |
Medicaid |
For members covered under UnitedHealthcare Medicaid (Community Plan) benefit plans, UnitedHealthcare will pay at state designated rates, unless specified otherwise. State-specific rules and other state regulations may apply. Some state agencies have not yet advised how they will cover this benefit or their reimbursement strategy. Please refer to your state-specific website or your state’s UnitedHealthcare Community Plan website for more details. |
Cost Share Information
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 cost share (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. This includes administration of a third dose to those who are moderately to severely immunocompromised as defined by the CDC.
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. This includes administration of a third dose to those who are moderately to severely immunocompromised as defined by the CDC. 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.
Reminder: At the time of service, you should not ask UnitedHealthcare members for payment of any costs associated with the COVID-19 vaccine.
Vaccine-related services
If members receive additional services during their vaccination appointments, they may be responsible for copays, deductibles, coinsurance or out-of-network charges, according to their benefits plan.
Health care professionals should not charge members for standard observation (15–30 minutes after receiving the vaccination).
UnitedHealthcare pays an administrative fee to the health care professional that covers the vaccine administration and the member’s observation following the vaccination with no cost share.
Roster billing is a way for health care professionals to submit multiple claims at once for mass immunization practices.
We’re working with Exela Technologies — an outside vendor company — to help facilitate the roster billing process. Before you submit claims, please ensure you meet the following criteria for roster billing:
If you qualify for roster billing, follow the steps outlined in the UnitedHealthcare roster billing quick reference guide to submit new claims.
These resources may be helpful as you manage the claim submission and reimbursement process for COVID-19 vaccine administration:
Resources
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.