Guidance for Providers Treating MVP Health Care Members
MVP covers approved COVID-19 vaccines at no cost-share to Members in all plans.
Medicare Members
Effective January 1, 2022, MVP Health Care® (MVP) will reimburse Participating Providers and out-of-network Providers for the cost of COVID-19 vaccines and their administration, as well as antibody treatment, to MVP Members enrolled in Medicare Advantage in 2022. Providers should no longer submit claims to Medicare Fee-for-Service.
New York Commercial and Medicaid Members
When COVID-19 vaccine doses are provided by the government without charge, only bill for the vaccine administration. MVP will reimburse Providers for the administration of the vaccine when the following codes are used:
| CPT Code | Description |
| 0001A | Pfizer-BioNtech Immunization Administration, first dose |
| 0002A | Pfizer-BioNtech Immunization Administration, second dose |
| 0003A | Pfizer-BioNtech Immunization Administration, third dose |
| 0004A | Pfizer-BioNtech Immunization Administration, booster dose |
| 0011A | Moderna Immunization Administration, first dose |
| 0012A | Moderna Immunization Administration, second dose |
| 0013A | Moderna Immunization Administration, third dose |
| 0031A | Janssen (Johnson & Johnson) Immunization Administration, first dose |
| 0034A | Janssen (Johnson & Johnson) Immunization Administration, booster dose |
| 0051A | Pfizer-BioNTech Immunization Administration, preservative free, first dose |
| 0052A | Pfizer-BioNTech Immunization Administration, preservative free, second dose |
| 0053A | Pfizer-BioNTech Immunization Administration, preservative free, third dose |
| 0054A | Pfizer-BioNTech Immunization Administration, preservative free, booster dose |
New York Providers should not include the vaccine codes (91300, 91301, and 91303) on the claim when the vaccines are free.
Vaccine codes should not be included on claims when the vaccines are free of charge:
| CPT Code | Description |
| 91300 | Pfizer-BioNtech vaccine |
| 91301 | Moderna vaccine |
| 91303 | Janssen (Johnson & Johnson) vaccine |
| 91305 | Pfizer-BioNTech, preservative free |
Antibody Treatment Codes
Note: Codes M0249-50 and Q0249 should be used for inpatient only.
| CPT Code | Description |
| M0240 | Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring, subsequent repeat doses |
| M0241 | Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring in the home or residence, this includes a beneficiary’s home that has been made Provider-based to the hospital during the COVID-19 public health emergency, subsequent repeat doses |
| M0243 | Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring |
| M0244 | Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring in the home or residence; this includes a beneficiary’s home that has been made Provider-based to the hospital during the COVID-19 public health emergency |
| M0245 | intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring |
| M0246 | Intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring in the home or residence; this includes a beneficiary’s home that has been made Provider-based to the hospital during the COVID-19 public health emergency |
| M0247 | Intravenous infusion, sotrovimab, includes infusion and post administration monitoring |
| M0248 | Intravenous infusion, sotrovimab, includes infusion and post administration monitoring in the home or residence; this includes a beneficiary’s home that has been made Provider-based to the hospital during the COVID-19 public health emergency |
| M0249 | Intravenous infusion, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older) with COVID-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) only, includes infusion and post administration monitoring, first dose |
| M0250 | Intravenous infusion, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older) with COVID-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) only, includes infusion and post administration monitoring, second dose |
| Q0240 |
Injection, casirivimab and imdevimab, 600 mg |
| Q0243 | Injection, casirivimab and imdevimab, 2400 mg |
| Q0244 | Injection, casirivimab and imdevimab, 1200 mg |
| Q0245 |
Injection, bamlanivimab and etesevimab, 2100 mg |
| Q0247 | Injection, sotrovimab, 500 mg |
| Q0249 | Injection, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older) with COVID-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) only, 1 mg |
Vermont Only
MVP Commercial Members
In addition to the vaccine administration code, Vermont Providers must also include the vaccine code— billed with a $0.00 or $0.01 charge on the claim. COVID-19 vaccines are not considered state-supplied; therefore, Providers should not use the SL modifier.
| Administration Code | Short Description |
CPT Code | Description |
| 0001A | Pfizer vaccine – 1st dose | 91300 |
12/11/2020 |
| 0002A | Pfizer vaccine – 2nd dose | 91300 | 12/11/2020 |
| 0003A | Pfizer vaccine – 3rd dose |
91300 | 8/12/2021 |
| 0004A* | Pfizer vaccine – Booster | 91300 | 9/22/2021 |
| 0011A | Moderna vaccine – 1st dose |
91301 | 12/18/2020 |
| 0012A | Moderna vaccine – 2nd dose |
91301 |
12/18/2020 |
| 0013A | Moderna vaccine – 3rd dose | 91301 | 8/12/2021 |
| 0031A | Janssen/Johnson & Johnson vaccine – 1st dose |
91303 |
2/27/2021 |
| 0034A* | Janssen/Johnson & Johnson vaccine – Booster |
91303 | 10/20/2021 |
| 0051A | Pfizer ready-to-use vaccine – 1st dose |
91305 | 9/22/2021 |
| 0052A |
Pfizer ready-to-use vaccine – 2nd dose | 91305 | 9/22/2021 |
| 0053A | Pfizer ready-to-use vaccine – 3rd dose |
91305 | 9/22/2021 |
| 0054A* | Pfizer ready-to-use vaccine –Booster |
91305 | 9/22/2021 |
| 0064A* |
Moderna lower dose vaccine – Booster |
91306 | 10/20/2021 |
| 0071A | Pfizer Pediatric vaccine – 1st dose |
91307 | 10/29/2021 |
| 0072A | Pfizer Pediatric vaccine – 2nd dose |
91307 | 10/29/2021 |
Following AMA and CMS guidance, the administration code must match the manufacturer code of the vaccine provided at the encounter. The Vaccine Administration (Vermont Only) Payment Policy will be updated with these additional codes. For additional details, review our current payment policy , then select Vaccine Administration (Vermont Only).
MVP Medicare Advantage Plan Members
As of January 1, 2022, COVID-19 vaccine administration claims for MVP Medicare Advantage Plan Members should be submitted to MVP. Providers should not include the vaccine codes on the claim, when COVID-19 vaccine doses are provided by the government at no charge and should only bill for the vaccine administration.