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COVID-19 VACCINES GUIDELINES<br />
COVID 19 VACCINE AGES TYPE OF CODE CPT ECW CPT NAME<br />
EFFECTIVE<br />
J&J<br />
(JANSSEN)<br />
18 & OLDER<br />
VACCINE<br />
1ST DOSE ADMIN<br />
91303<br />
0031A<br />
COVID 19 (JANSSEN) >18YRS<br />
COVID-19 IM ADMIN (J&J) BOOSTER<br />
COMPONENT<br />
2/27/2021<br />
VACCINE<br />
91301<br />
COVID 19 (MODERNA) >18YRS<br />
1ST DOSE ADMIN<br />
2ND DOSE ADMIN<br />
0011A<br />
0012A<br />
COVID-19 IM ADMIN (MODERNA) 1ST<br />
COMPONENT<br />
COVID-19 IM ADMIN (MODERNA) 2ND<br />
COMPONENT<br />
12/18/2020<br />
MODERNA<br />
18 & OLDER<br />
3RD DOSE ADMIN<br />
0013A<br />
COVID-19 IM ADMIN (MODERNA) 3RD<br />
COMPONENT<br />
BOOSTER VACCINE<br />
BOOSTER ADMIN<br />
91306<br />
0064A<br />
BOOSTER-COVID 19 (MODERNA-0.25ML)<br />
>18YRS *7990<br />
COVID-19 IM ADMIN (0.25 ML MODERNA)<br />
BOOSTER COMPONENT<br />
10/20/2021<br />
VACCINE<br />
91300<br />
COVID-19 (PFIZER) >12YRS<br />
1ST DOSE ADMIN<br />
0001A<br />
COVID-19 IM ADMIN (PFIZER) 1ST<br />
COMPONENT<br />
8/12/2021<br />
PURPLE<br />
2ND DOSE ADMIN<br />
0002A<br />
COVID-19 IM ADMIN (PFIZER) 2ND<br />
COMPONENT<br />
3RD DOSE ADMIN<br />
0003A<br />
COVID-19 IM ADMIN (PFIZER) 3RD<br />
COMPONENT<br />
10/20/2021<br />
PFIZER<br />
12 & OLDER<br />
BOOSTER ADMIN 0004A COVID-19 IM ADMIN (PFIZER) BOOSTER 9/22/2021<br />
VACCINE<br />
91305<br />
COVID 19 (PFIZER- GRAY) >12YRS<br />
1ST DOSE ADMIN<br />
0051A<br />
COVID-19 IM ADMIN (PFIZER-GRAY) 1ST<br />
DOSE<br />
GRAY<br />
2ND DOSE ADMIN<br />
0052A<br />
COVID-19 IM ADMIN (PFIZER-GRAY) 2ND<br />
DOSE<br />
1/3/2022<br />
3RD DOSE ADMIN<br />
0053A<br />
COVID-19 IM ADMIN (PFIZER-GRAY) 3RD<br />
DOSE- IMMUNO<br />
BOOSTER ADMIN<br />
0054A<br />
COVID-19 IM ADMIN (PFIZER-GRAY)<br />
BOOSTER<br />
VACCINE<br />
91307<br />
COVID 19 (PFIZER) PEDIATRIC 5-11YRS<br />
PFIZER<br />
PEDIATRICS<br />
ORANGE<br />
CHILDREN<br />
5-11<br />
1ST DOSE ADMIN<br />
2ND DOSE ADMIN<br />
0071A<br />
0072A<br />
COVID-19 IM ADMIN CHILD - (PFIZER) 1ST<br />
COMPONENT<br />
COVID-19 IM ADMIN CHILD - (PFIZER) 2ND<br />
COMPONENT<br />
10/29/2021<br />
Do not collect from self-pay patients for COVID vaccines and/or Free COVID testing.
R E M I N D E R S<br />
PATIENTS' BENEFIT VERIFICATION<br />
Please be sure we are verifying:<br />
Benefits on all patients as well as collecting<br />
co-pays, deductibles and/or co-insurances at<br />
the time of the service. (please use Master<br />
Fee Schedule for collecting deductibles / coinsurances)<br />
Patient's benefits through TMHP and<br />
payor's portal every time a patient returns<br />
to clinic.<br />
That the provider is linked to Topcare<br />
<strong>Medical</strong> <strong>Group</strong> Inc.<br />
Benefits to know if Sports Physical is a<br />
covered benefit, for Superior Ambetter<br />
PAYOR SPECIFIC<br />
All Medicaid Insurance needs to be verified<br />
on the 1st of every month.<br />
If patient has a Dual Plan please make sure<br />
you use the presentation provided "Dual<br />
Policies" to verify insurance and load<br />
correct Medicaid and Medicare plans.<br />
If patient has CHC we must obtain<br />
authorization for CPT 17340 prior to<br />
performing.<br />
If the patient has BCBS HMO then they<br />
should not add BCBS PPO to the patients<br />
account but add BCBS HMO insurance<br />
record.<br />
PATIENTS' INFORMATION<br />
Please remember to update patient's<br />
information such as address and telephone<br />
number. Please update Medicare patient<br />
accounts with their new identification cards.<br />
Make sure that for children the<br />
demographics contains<br />
GUARANTOR/RESPONSIBLE PARTY. We<br />
are seeing numerous account where this is<br />
missing.<br />
If patient with insurance signs the "Self-Pay<br />
Form" please remove insurance from claim<br />
at the time of creation.<br />
PATIENT BALANCE<br />
If patient has an outstanding balance, please<br />
collect balances based upon our payment<br />
arrangements and/or call CBO to resolve<br />
with patient collections (ext. 8124)<br />
PCP INFORMATION LOGIN<br />
For all HMO’s, staff should update the PCP<br />
to our provider treating the patient at the<br />
time of service.<br />
Amerigroup has finished loading<br />
Amerivantage to our providers. You can call<br />
Amerigroup and they should be able to<br />
change PCP.<br />
EMPLOYEE FEE SCHEDULE<br />
If employee is coming for Office Visit,<br />
choose "Employee Fee Schedule" and<br />
adjust $0.01 under employee adjustment<br />
only. Do not adjust any other service<br />
done. Charges from "Employee Fee<br />
Schedule" are already adjusted and should<br />
be collected when performed.<br />
Give your best effort, because<br />
you are worth your best results.
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