Billing for COVID-19 vaccinations

May 19, 2021

The following information has been prepared to assist physicians in billing for COVID vaccinations in three different scenarios. For specific wording or other information about the individual health service codes listed herein, consult the AMA Fee Navigator® or the Schedule of Medical benefits (SOMB Procedure List)

Physician-supervised vaccinations in own office

• Physicians may claim 13.59V for each vaccination that either they provide, or qualified staff authorized to administer vaccines under their standards of practice (e.g. LPNs) working in their office, under their supervision provided to a patient, as long as the requirements noted in MED 242 are met.
• Where the patient has an immediate post-vaccination reaction, or the physician is required to counsel patient at the time of vaccination regarding vaccine hesitancy, questions, etc., AND the physician spends >10 minutes with the patient, claim 13.59VA, in addition to 13.59V. The patient’s record must describe counselling provided, any adverse reactions to the vaccine, as well as start and stop time of the physician’s direct service to the patient.
• Bulletin MED 242 also requires that the physician or appropriate member of their staff also review Alberta Netcare or another appropriate patient record system to ensure that the vaccine dose being provided is appropriately sequenced, and that the physician record the vaccination in the Immunization Direct Submission Mechanism. Physicians must be sure to record the vaccination in the Immunization Direct Submission Mechanism as there are fines starting at $100,000 for the first offence for failure to record the vaccination.

If a physician cares for a patient who has a severe reaction to the vaccine, AMA can assist in the process for making a claim. Contact Norma Shipley (norma.shipley@albertadoctors.org) or D’Arcy Shade (darcy.shade@albertadoctors.org) for assistance.

Physician working in an AHS-organized and supported mass vaccination clinic

• Physicians working in AHS-organized and supported mass vaccination clinics, regardless of location, may claim 13.59V when they vaccinate the patients themselves.
  • General supervision of Alberta Health Services mass vaccination sites may not be claimed o AHS will provide the required information to the physician for patients they have vaccinated themselves to allow them to be claimed.
  • Physicians will be responsible for securely retaining the information provided by AHS to support billing for 6 years after the date of service.
  • Other provisions of 13.59V must be met at the time of vaccination, including obtaining consent, discussion of benefits and risks with the patient, monitoring for immediate post-vaccination adverse effects, updating the IDSM, and completing the patient record.
• When the physician spends more than 10 minutes on work related to the individual patient because of concerns regarding the vaccination or immediate post-vaccination adverse reactions they may claim 13.59VA. The physician must create and retain a patient record describing the counselling provided, any adverse reaction to the vaccine, as well as start and stop time of the physician’s direct service to the patient.
• Bulletin MED 242 also requires that the physician (or an individual under their supervision or observation) review Alberta Netcare or another appropriate patient record system to ensure that the vaccine dose being provided is appropriately sequenced, and that the vaccination is recorded in the Immunization Direct Submission Mechanism.
• Physicians who administer vaccines at AHS facilities with no facility ID (e.g., special temporary facilities set up for administering vaccines) may use location “OTHR” to submit claims. To do this, leave both the facility number and functional center blank; look for the location data field and enter “OTHR” there.