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COVID-19 Vaccines

We are closely following advancements in the prevention and treatment of COVID-19. As a healthcare provider, you play an integral role in the COVID-19 vaccine process.

Similar to other COVID-19 services, the vaccines will be offered at no cost to your patients. In addition:

  • We will configure our systems to properly adjudicate COVID-19 vaccine-related administration claims in accordance with the state of Florida’s coverage determinations for Medicaid beneficiaries 
  • Member liability will be $0
  • No prescription or prior authorization is needed for all provider types, regardless of network status
  • Provider reimbursement rates and emergency use authorizations (EUA) are all still pending and we will update you as that information becomes available

The American Medical Association published vaccine-specific CPT codes to report immunizations for COVID-19, and CMS published billing guidance (PDF) for Medicaid and CHIP providers. CMS also has published a set of toolkits to help providers swiftly administer the vaccine.

Medicaid-enrolled provider types that are eligible to provide the vaccine (must have a Medicaid ID) include: physicians, extenders, pharmacies (via pharmacists), Federally Qualified Health Centers, rural health clinics and county health departments.

All providers administering COVID vaccines must be enrolled in the federal COVID-19 vaccine program. Providers must report COVID vaccinations in SHOTS. The Pfizer vaccine is approved for ages 16 and up. The Moderna vaccine is approved for ages 18 and up. 

Current Procedural Terminology (CPT®) codes

Code

CPT Short Descriptor

Labeler Name

Vaccine/Procedure Name

91300

SARSCOV2 VAC
30MCG/0.3ML IM

Pfizer

Pfizer-BioNTech Covid-19 Vaccine

0001A

ADM SARSCOV2 VAC
30MCG/0.3ML 1ST

Pfizer

Pfizer-BioNTech Covid-19 Vaccine Administration – First Dose

0002A

ADM SARSCOV2 VAC30MCG/0.3ML 2ND

Pfizer

Pfizer-BioNTech Covid-19 Vaccine Administration – Second Dose

91301

SARSCOV2 VAC100MCG/0.5ML IM

Moderna

Moderna Covid-19 Vaccine

0011A

ADM SARSCOV2 VAC100MCG/0.5ML 1ST

Moderna

Moderna Covid-19 Vaccine
Administration – First Dose

0012A

ADM SARSCOV2 VAC
100MCG/0.5ML 2ND

Moderna

Moderna Covid-19 Vaccine
Administration – Second Dose

This list will be updated as additional vaccines become available. 

Your patients will likely have a lot of questions about the vaccine, and as their healthcare provider, they will turn to you for answers.

Q: Can I make an appointment with you to be vaccinated? If not, why? Do I have to go to a pharmacy to receive the vaccine?

A: Pharmacies are generally the most convenient locations to individuals and they also have great expertise in administering vaccines. While many providers anticipate to have the vaccine in their office later on, for now we recommend patients visit their local pharmacy. The Vaccine Finder website can help them locate the closest location with current inventory.

Q: Why are some people getting the vaccine before others? Why can’t I get mine yet?

A: Initially, there will be a limited number of vaccines available. Because of the limited supply, some groups are recommended to get the vaccine first:

  • Phase 1A will include residents and employees of nursing homes and Long Term Care facilities.  They are recommended to get the vaccine first, as they are deemed highly vulnerable. Long Term Care facilities account for a high percentage of the deaths from COVID-19 (40%).
  • Federal and state governments are developing additional phases. This will address first-responders, essential workers, older adults and people more at risk for either contracting the virus or becoming seriously ill with the virus.

Q: How do we really know if COVID-19 vaccines are safe? 

A: The Food and Drug Administration (FDA) carefully reviews all safety data from clinical trials. It only authorizes emergency vaccine use when the expected vaccine benefits outweigh potential risks.

  • The Advisory Committee on Immunization Practices (ACIP) reviews all safety data before recommending any COVID-19 vaccine for use.
  • FDA and CDC will continue to monitor the safety of COVID-19 vaccines to make sure even very rare side effects are identified.

Q: Is the vaccine that helpful? I heard getting COVID-19 gives you better and longer immunity than the protection a vaccine can give. Can it actually make my illness worse if I do end up getting COVID-19? 

A: Explain the potential serious risk COVID-19 infection poses to them and their loved ones if they get the illness or spread it to others.

  • Remind them of the potential for long-term health issues after recovery from COVID-19 disease, especially for those who have chronic conditions, are older, or have weakened immune systems.
  • Explain that scientists are still learning more about the virus that causes COVID-19. And it is not known whether getting COVID-19 disease will protect everyone against getting it again, or, if it does, how long that protection might last. Therefore getting a vaccine is a safer choice.
  • Some vaccines are more effective than the natural illness; it is not clear whether natural illness or vaccination will provide more effective immunity in this case.
  • Early information indicates that COVID-19 vaccination may reduce the severity of illness, as well as the incidence of illness. As we learn more about the efficacy of the vaccine, we will also learn more about potential long-term protection it may bring.
  • Describe how the vaccine was tested in large clinical trials and what is currently known about its safety and effectiveness.
  • Be transparent that the vaccine is not a perfect fix. Patients will still need to practice other precautions like wearing a mask, social distancing, handwashing and other hygiene measures until public health officials say otherwise.

Q: I heard I need two vaccines. Why? I don’t want to come back for a second vaccine.

A: Two vaccines are needed to provide the best protection against COVID-19.

  • The first vaccine primes the immune system and helps recognize the virus. The second vaccine strengthens the immune response.
  • The two doses are given a few weeks apart (e.g. 21 or 28 days depending on vaccine type). Explain the dosing options available in your office and advise the patient that they can set up an appointment before they leave to come back for a second dose.
  • Provide members with a vaccination record card to ensure that they know when they received their first vaccine, what type of vaccine they received and when they need to come back and receive their second vaccine.
  • Direct them to their insurance health plan to set up non-emergency transportation, if applicable.

Q: Will the shot hurt? Can it cause me to get sick? I don’t want to get the vaccine because it will give me COVID.

A: List the most common side effects from vaccination are and how severe they may be (e.g. fever, headache, body aches, cold symptoms). Emphasize that a fever could be a potential side effect and when to seek medical care.

  • Symptoms will typically go away on their own within a week. Let them know when they should seek medical care if their symptoms don’t go away.
  • Explain that the vaccine cannot give someone COVID-19 as the vaccine does not contain a live coronavirus.
  • Explain that side effects are a sign that the immune system is effectively working.

Q: Do I have to pay for my vaccines?

A: No. The vaccine will be at no cost to patients. They will not have to pay for either dose of the COVID-19 vaccine.

Patients look to their healthcare professionals for medical guidance and assurance. As your partners in healthcare, we want to share some tips for effectively setting expectations and addressing questions from your patients.

Start COVID-19 Vaccine Conversations Early

Even before you are able to offer COVID-19 vaccinations, consider including the topic in your conversations with patients. This will give you the opportunity to set expectations about vaccine availability, including if/when you might recommend vaccination for them, and learn about any concerns they have.

Engage in Effective COVID-19 Vaccine Conversations

Effective engagement can occur during an in-person office visit, through messages on your patient portal, or at a telemedicine appointment. Patients trust in their providers to help guide healthcare decisions, and your strong vaccine recommendation is the most important part of the conversation.

Start with empathy and understanding.

  • Acknowledge the disruption COVID-19 has caused in all our lives.
  • Provide an opportunity to recognize common concerns that can be addressed by a vaccine.

Assume patients will want to be vaccinated but may not know when to expect it.

  • Consider providing the following general information to patients about the timeline for COVID-19 vaccines:
    • Limited COVID-19 vaccine doses may be available in 2020.
    • It is anticipated that vaccine supply will increase substantially in 2021.
    • The goal is for everyone to be able to easily get a COVID-19 vaccine as soon as large quantities are available. However, not everyone will be able to get vaccinated right away.
  • Encourage patients to continue taking steps to protect themselves from COVID-19 and let them know how you plan to share updates about vaccine availability.

Give your strong recommendation.

  • Let your patients know if you plan to recommend COVID-19 vaccination for them.
  • Share the importance of COVID-19 vaccines to protect patients’ health as well as the health of those around them.
  • Talk about your personal plans to get a COVID-19 vaccine.
  • Reassure your patients that the vaccine is safe.

Listen and respond to questions.

  • If a patient has concerns or questions, this doesn’t mean they won’t accept a COVID-19 vaccine. Sometimes patients want your answers to their questions.
  • Your willingness to listen to their concerns will play a major role in building trust in you and your recommendation. Make it clear that you understand they have questions, and that you want to answer them, so they feel confident in choosing to get vaccinated.
  • Seek to understand patient/caregiver concerns and provide information they need in a way they can understand it.

Keep the conversation open.

  • After answering their questions, let your patients know that you are open to continuing the conversation and answering any additional questions they may have.
  • Encourage patients to take at least one action like:
    • Scheduling another appointment.
    • Reading any additional information you provide them about COVID-19 vaccination.
    • Encourage others to get their COVID-19 vaccine when available.
  • Continue to remind patients about the importance of getting a COVID-19 vaccine during future routine visits.
Last Updated: 01/11/2021