Priority Health: Changes to Billing for COVID-19 Vaccine and Lab Testing on January 1, 2022

November 3, 2021

From Priority Health:  On Jan. 1, 2022, changes to how the COVID-19 vaccine and lab testing services are covered will go into effect. 


What’s changing? 

We’ll start paying for Medicare members’ vaccines 

On January 1, you should begin billing us for the COVID-19 vaccine and its administration for all Medicare members enrolled in our plan. We’ll post the appropriate CPT codes in our Medicare fee schedules (login required). 

You should continue to bill Medicare through Dec. 31, 2021. For more, visit our COVID-19 vaccine information page.  


We’ll follow APC logic when paying for members’ COVID-19 lab testing services 

Starting January 1, we’ll follow the industry-wide Ambulatory Payment Classification (APC) reimbursement methodology, bundling payment for COVID-19 lab testing with services that have a J1 or J2 indicator – such as major surgical procedures and extended observation stays. We’ve been paying for these lab services separately, resulting in a higher payment. This change will reduce these payments to align our strategy with APC’s established payment practices.