Eligible patients can receive COVID‑19 vaccine at home

The COVID‑19 vaccine reimbursement has expanded to home health care agencies, allowing eligible patients to have the vaccine administered at their home. Home health care agencies have already begun administering vaccines to homebound patients.

Blue Cross Blue Shield of Michigan and Blue Care Network are following guidelines from the Centers for Medicare & Medicaid Services to determine which patients qualify for in‑home COVID‑19 vaccinations.

A patient qualifies if one of these scenarios apply:

• The patient has difficulty leaving the home to get the vaccine, which could mean any of these:

• They have a condition, due to an illness or injury, that restricts their ability to leave home without a supportive device or help from a caregiver.
• They have a condition that makes them more susceptible to contracting a pandemic disease such as COVID‑19.
• They are generally unable to leave the home, and if they do leave home, it requires a considerable effort

• The patient is hard to reach because they have a disability or face clinical, socioeconomic or geographical barriers to getting a COVID‑19 vaccine in settings other than their home. These patients face challenges that significantly reduce their ability to get vaccinated outside the home, such as challenges with transportation, communication or caregiving.

The provider must document in the patient’s medical record the clinical status or barriers that justify the patient’s need for an in‑home vaccination. The information described below and in the CMS links, regarding additional payment, applies if the only service provided during the home visit is administration of the COVID‑19 vaccine.

This temporary expansion of COVID‑19 vaccine coverage in the home for eligible patients was effective:

• June 8, 2021, for patients with Medicare coverage
• July 1, 2021, for patients with Blue Cross and BCN commercial coverage

This expansion will remain in place until further notice.

Here’s other information you need to know:

For eligible patients with commercial coverage
Follow these guidelines for eligible patients with Blue Cross or BCN commercial coverage:

• Contact us to enroll — Home health care agencies interested in administering the COVID‑19 vaccine to eligible commercial members in their homes need to contact Provider Enrollment and Data Management at 1‑800‑822‑2761 to enroll for this expanded service. You’ll receive notification when you can begin providing this service.
• Submit professional claims using standard vaccine administration codes plus M0201 — Once approved to provide this service, home health care agencies need to submit professional claims using standard COVID‑19 vaccine administration codes for dates of service July 1, 2021, and after.

In addition, home health care agencies approved for this service should include HCPCS Level II code M0201 to receive additional payment in recognition of the cost agencies incur for traveling to the patient’s home. We posted a web‑DENIS message regarding reimbursement for M0201 on July 15.
For M0201 to be payable, these requirements must be met:

• The service is provided to a patient who meets the above requirements.
• The provider documents justification for the service in the patient’s record.
• The only service provided was COVID‑19 vaccine administration.
• The service is administered in a home location (see Medicare Payment for COVID-19 Vaccination Administration in the Home for more information.)
• The code is reported only once per individual home per date of service.

The COVID‑19 vaccine administration codes are available on our COVID‑19 webpages within our provider portal or on our public website at bcbsm.com/coronavirus. Refer to COVID‑19 vaccine information for providers and COVID‑19 vaccine billing information at a glance for more information.

For eligible patients with Medicare primary or Medicare Advantage coverage:
Follow CMS guidelines for patients with Medicare Advantage coverage (Medicare Plus Blue℠ and BCN Advantage℠) and coverage with Medicare primary. More information is available at these links:

• MLN Connects^® special edition: Biden Administration Continues Efforts to Increase Vaccinations by Bolstering Payments for At‑Home COVID‑19 Vaccinations for Medicare Beneficiaries**
• Medicare COVID‑19 Vaccine Shot Payment webpage**
• Medicare Billing for COVID‑19 Vaccine Shot Administration**

**Blue Cross Blue Shield of Michigan and Blue Care Network don't own or control this website.