2023 Rates for COVID-19 Codes, CR 114822
Effective January 1, 2023, we updated the COVID-19 rates listed below. We adjusted affected claims on March 13, 2023.
|
Code |
Description |
Rate |
|
0001A |
imm admn sarscov2 30mcg/0.3ml dil recon 1st dose |
$39.11 |
|
0002A |
imm admn sarscov2 30mcg/0.3ml dil recon 2nd dose |
$39.11 |
|
0003A |
imm admn sarscov2 30mcg/0.3ml dil recon 3rd dose |
$39.11 |
|
0011A |
imm admn sarscov2 100 mcg/0.5 ml 1st dose |
$39.11 |
|
0012A |
imm admn sarscov2 100 mcg/0.5 ml 2nd dose |
$39.11 |
|
0013A |
imm admn sarscov2 100 mcg/0.5 ml 3rd dose |
$39.11 |
|
0031A |
imm admn sarscov2 ad26 5x1010vp/0.5 ml 1 dose |
$39.11 |
|
0034A |
imm admn sarscov2 ad26 5x1010 vp/0.5 ml bst dose |
$39.11 |
|
0041A |
imm admn sarscov2 5 mcg/0.5 ml 1st dose |
$39.11 |
|
0042A |
imm admn sarscov2 5 mcg/0.5 ml 2nd dose |
$39.11 |
|
0044A |
imm admn sarscov2 5 mcg/0.5 ml bst |
$39.11 |
|
0051A |
imm admn sarscov2 30mcg/0.3ml tris-sucrose 1st |
$39.11 |
|
0052A |
imm admn sarscov2 30mcg/0.3ml tris-sucrose 2nd |
$39.11 |
|
0053A |
imm admn sarscov2 30mcg/0.3ml tris-sucrose 3rd |
$39.11 |
|
0071A |
imm admn sarscov2 10mcg/0.2ml tris-sucrose 1st |
$39.11 |
|
0072A |
imm admn sarscov2 10mcg/0.2ml tris-sucrose 2nd |
$39.11 |
|
0073A |
imm admn sarscov2 10mcg/0.2ml tris-sucrose 3rd |
$39.11 |
|
0081A |
imm admn sarscov2 3mcg/0.2ml tris-sucrose 1st |
$39.11 |
|
0082A |
imm admn sarscov2 3mcg/0.2ml tris-sucrose 2nd |
$39.11 |
|
0083A |
imm admn sarscov2 3mcg/0.2ml tris-sucrose 3rd |
$39.11 |
|
0091A |
imm admn sarscov2 50 mcg/0.5 ml 1st dose 6-11 |
$39.11 |
|
0092A |
imm admn sarscov2 50 mcg/0.5 ml 2nd dose 6-11 |
$39.11 |
|
0093A |
imm admn sarscov2 50 mcg/0.5 ml 3rd dose 6-11 |
$39.11 |
|
0111A |
imm admn sarscov2 25 mcg/0.25 ml 1st dose |
$39.11 |
|
0112A |
imm admn sarscov2 25 mcg/0.25 ml 2nd dose |
$39.11 |
|
0113A |
imm admn sarscov2 25 mcg/0.25 ml 3rd dose |
$39.11 |
|
0124A |
imm admn sarscov2 bivalent 30 mcg/0.3 ml bst |
$39.11 |
|
0134A |
imm admn sarscov2 bivalent 50 mcg/0.5 ml bst |
$39.11 |
|
0144A |
imm admn sarscov2 bivalent 25 mcg/1.25 ml bst |
$39.11 |
|
0154A |
imm admin sarscov2 bivalet 10 mcg/0.2 ml bst |
$39.11 |
|
0164A |
imm admn sarscov2 bivalent 10 mcg/0.2 ml bst |
$39.11 |
|
0173A |
imm admn sarscov2 bivalent 3 mcg/0.2 ml 3rd |
$39.11 |
|
M0201 |
COVID-19 vaccine home admin |
$34.71 |
|
M0220 |
Tixagevimab and cilgavimab inj and post adm mon – Ending 01/25/2023 |
$102.64 |
|
M0221 |
Tixagevimab and cilgavimab inj home – Ending 1/25/2023 |
$170.84 |
|
M0249 |
Admin Tocilizu COVID-19 1st |
$306.90 |
|
M0250 |
AdmIN Tocilizu COVID-19 2nd |
$306.90 |
Please contact your Provider Relations Specialist with questions.
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