COVID-19 Vaccine Toolkit

We are working with our community partners, public officials and others to help ensure everyone who wants the vaccine receives it and that underserved communities and people of color – groups that have been disproportionally affected by the pandemic – are vaccinated.

Providers that participate in the Centers for Disease Control and Prevention (CDC) COVID-19 Vaccination Program contractually agree to administer a COVID-19 vaccine regardless of an individual’s ability to pay and regardless of their coverage status, and also may not seek any reimbursement, including through balance billing, from a vaccine recipient.

Health alert

The CDC has issued a health alert about the rapid increase in Ivermectin prescriptions and reports of severe illness associated with products containing Ivermectin to prevent or treat COVID-19.

Emergency use authorizations and FDA approvals

All vaccines must receive Emergency Use Authorization (EUA) or approval from the U.S. Food and Drug Administration (FDA) before they can be distributed to the public.

  • EUAs can be used by the FDA during public health emergencies to provide access to medical products that may be effective in preventing, diagnosing or treating a disease, provided that the FDA determines that the known and potential benefits of a product, when used to prevent, diagnose or treat the disease, outweigh the known and potential risks of the product.
  • FDA-approved vaccines undergo the agency’s standard process for reviewing the quality, safety and effectiveness of medical products.

COVID-19 vaccines

View the FDA's website for information about authorizations and approvals.

Distribution

Learn about the states’ vaccination distribution plans:

Coverage for our members

  • Vaccines: During the public health emergency, the federal government will pay for the cost of the COVID-19 vaccine and boosters for all individuals.
  • Administration: Depending on the individual, additional costs associated with administering the vaccine or booster will be covered by the federal government or the member’s health plan.
    • The administration of the vaccine or booster is covered at no out-of-pocket cost for Medicare, fully insured and most adminstrative services only (ASO) members.
  • Note: Grandfathered and retiree only plans are not required to cover administration without cost-sharing. However, we have chosen to cover the administrative fee for fully insured grandfathered and retiree only plans without cost-sharing. We are reaching out to ASO groups with grandfathered and retiree only plans to confirm whether they will cover the vaccine and waive cost-sharing for their members.

Only the vaccine or booster and related administration will be covered at no cost share. An office visit can only be billed with a vaccine if it is for a “separate distinct procedural service.” For the office visit, the member will be responsible for any copayments or coinsurance based on their coverage.

Claims submission

Commercial

For dates of service through December 31, 2021

For dates of service on or after January 1, 2022

Vaccine administration

Providers need to submit claims to Regence for reimbursement of the vaccine administration.

We will cover the administration fees per the member’s benefit. Administration fees will need to be billed based on the codes assigned to the manufacturer’s vaccine.

Note: Retail pharmacies can file vaccine claims under the medical or pharmacy benefits for commercial members.

Providers need to submit claims to Regence for reimbursement of the vaccine administration.

We will cover the administration fees per the member’s benefit. Administration fees will need to be billed based on the codes assigned to the manufacturer’s vaccine.

Note: Retail pharmacies can file vaccine claims under the medical or pharmacy benefits for commercial members.

Vaccine

Claims for COVID-19 Vaccines (drugs) do not need to be submitted to Regence.

However, if required by your claim system, the vaccine can be included in the non-covered services column on the administration claim submitted to Regence.

Claims for COVID-19 Vaccines (drugs) received at no cost to the provider do not need to be submitted to Regence.

However, if required by your claim system, the vaccine can be included in the non-covered services column on the administration claim submitted to Regence.

Medicare Advantage

For dates of service through December 31, 2021

For dates of service on or after January 1, 2022

Vaccine administration

Providers need to submit claims to Original Medicare for the administration.

View instructions for submitting institutional and professional claims for the vaccine shot administration.

When submitting claims to CMS, use the member’s Medicare Beneficiary ID# (MBI#) (not the member’s Regence member ID number).

Note: For Medicare Advantage members, if providers submit vaccine-related claims to Regence for dates of service through December 31, 2021, the system will deny the claim and advise the provider to file to Original Medicare.

Providers need to submit claims to Regence for reimbursement of the vaccine administration.

Note: For Medicare Advantage members, if providers submit vaccine-related claims to Original Medicare for dates of service on or after January 1, 2022, the system will deny the claim and advise the provider to file to Regence.

Vaccine

Providers need to submit claims to Original Medicare for the vaccine.

Claims for COVID-19 Vaccines (drugs) received at no cost to the provider do not need to be submitted to Regence.

However, if required by your claim system, the vaccine can be included in the non-covered services column on the administration claim submitted to Regence.

Codes and reimbursement

The American Medical Association (AMA), Centers for Medicare & Medicaid Services (CMS) and the Centers for Disease Control and Prevention (CDC) collaborated to establish Current Procedural Terminology (CPT) codes and reimbursement for the COVID-19 vaccines, as well as the administration.

Learn more

State resources

View resources, guidance and other information for those providers enrolled in or interested in enrolling in the state’s vaccination program:

Other resources
View these helpful resources to learn more:

View all COVID-19 updates and resources.