CMS, private payers respond to COVID-19 vaccine administration snafu

CMS will expedite the next National Correct Coding Initiative (NCCI) update to stop denials when a provider reports administration of the COVID-19 vaccine and another vaccine code for the same patient on the same day.

 

The NCCI procedure-to-procedure (PTP) update for Oct. 1, 2025, mistakenly bundled 90480 (Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] [coronavirus disease {COVID-19}] vaccine, single dose) into dozens of vaccine codes, including influenza and respiratory syncytial virus (RSV) vaccines.

 

According to National Government Services, Medicare administrative contractors (MAC) “will receive the January 2026 NCCI PTP files on or around 11/24/2025 to implement as soon as possible. Once the new files are implemented, claims will no longer be denied in error.”

 

All seven MACs have posted similar notices. Check your MAC’s website if you haven’t received an email.

 

You don’t need to take any action if you’ve been hit with denials, but you should keep an eye on your remittance advices. Your MAC will automatically adjust improperly denied services within 30 days of receiving the new file. If you feel your MAC improperly denied claims for 90480 after the adjustment, you can appeal.

 

Check with your private payers that use the NCCI edit set for guidance. For example, Blue Cross/Blue Shield of North Dakota updated its system to allow providers to report 90480 with a distinct procedure modifier (59, XE, XP, XS or XU) to bypass the edit, effective Oct. 17.

 

This isn’t the first NCCI conflict involving 90480 this year. CMS deleted an edit that bundled vaccine administration codes for influenza (G0008), pneumonia (G0009) and hepatitis B (G0010) into the code, according to an Oct. 14 notice. The agency backdated the deletion to July 1.

 

As you prepare for the new year, train your coding staff on the revisions to COVID-19 vaccine administration. The descriptor for 90480 will be revised:

You’ll report additional components with add-on code 90481.

 

Part B News subscribers will find more information about the changes to COVID-19 vaccination codes in upcoming issues.