COVID-19 Vaccine Billing for Medicare Advantage Members

November 24, 2021

Starting Jan. 1, 2022, Blue Cross and Blue Shield of New Mexico (BCBSNM) will cover the cost of COVID-19 vaccines and their administration for Blue Cross Medicare Advantage members instead of the Original Medicare program (also known as fee-for-service Medicare). Medicare Advantage members will continue to have no cost-sharing during their 2022 benefit year for COVID-19 vaccines and their administration, including approved booster doses.

What This Means for You

  • Through Dec. 31, 2021: For Medicare Advantage members you vaccinate through Dec. 31, submit claims for the vaccine and its administration to the CMS Medicare Administrative Contractor (MAC) using product-specific codes for each vaccine approved. Payment for the vaccine and its administration is through the Original Medicare program until the end of the year.
  • Starting Jan. 1, 2022: For Medicare Advantage members you vaccinate on or after Jan. 1, follow your normal submission process to BCBSNM or refer to the member’s ID card for billing instructions when submitting vaccine and administration claims.

Reimbursement

  • In-network providers will be reimbursed for the COVID-19 vaccine and administration fee based on contracted rates.
  • Out-of-network providers will be reimbursed based on established out-of-network reimbursement policy that follows Medicare rates.

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