Changes to COVID-19 vaccine and lab testing billing coming Jan. 1, 2022

On Jan. 1, 2022, changes to how the COVID-19 vaccine and lab testing services are covered will go into effect.

What’s changing?

We’ll start paying for Medicare members’ vaccines

On January 1, you should begin billing us for the COVID-19 vaccine and its administration for all Medicare members enrolled in our plan. We’ll post the appropriate CPT codes in our Medicare fee schedules (login required).

You should continue to bill Medicare through Dec. 31, 2021. For more, visit our COVID-19 vaccine information page.

We’ll follow APC logic when paying for members’ COVID-19 lab testing services

Starting January 1, we’ll follow the industry-wide Ambulatory Payment Classification (APC) reimbursement methodology, bundling payment for COVID-19 labs with services that have a J1 or J2 indicator – such as major surgical procedures and extended observation stays. We’ve been paying for these lab services separately. This change will align our payment strategy with APC’s established payment practices.

If you have questions, please reach out to your provider performance specialist.