Fighting Fraud, Waste and Abuse: Billing a COVID-19 Vaccine Administration

Posted September 23, 2021

Blue Cross and Blue Shield of Illinois (BCBSIL) has become aware of several cases involving Evaluation and Management (E/M) visits being billed on the same claim as COVID-19 immunization administration services. BCBSIL’s guidelines state, “When billing a vaccine administration code with an office visit, if the vaccine is not the primary purpose of the office visit, bill the vaccine on a separate claim.”

The American Medical Association (AMA) published guidelines concerning COVID-19 immunization administration Healthcare Common Procedure Coding System (HCPCS) codes and E/M Current Procedural Terminology (CPT^®) code billing. BCBSIL encourages all providers offering COVID-19 immunization services to review this guidance . According to AMA guidelines, the vaccine counselling provided by a physician or qualified health care professional is included in the vaccine administration code. Consequently, when there is no separately identifiable service performed during the same visit, the provider should not be billing for an E/M visit.

If you are aware of an instance of potential fraud, waste and/or abuse, we encourage you to file a report online  or call the BCBSIL Fraud Hotline at 877-272-9741 to create a report. All online reports and calls are confidential, and you may remain anonymous. For more information, visit our Fraud and Abuse page.

CPT copyright 2020 American Medical Association (AMA). All rights reserved. CPT is a registered trademark of the AMA.

The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment. The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider. The information provided does not constitute legal advice.