Anthem Blue Cross implements fix for pediatric COVID-19 vaccine underpayments

December 17, 2021

Anthem Blue Cross has reported progress in addressing underpayments tied to the newly approved COVID-19 vaccine for the 5–11-year-old pediatric population.  As previously reported, Anthem Blue Cross was reimbursing COVID-19 vaccine administration codes for the newly approved 5–11-year-old COVID-19 vaccine at unreasonably low rates—less than 20% of the Centers for Medicare and Medicaid Services (CMS) reimbursement rate of $40/shot. Anthem had advised that while the new codes, CPT 0071A and 0072A, had been loaded into its systems, and physicians could submit claims using the new codes, the pricing of these codes had not been completed, resulting in underpayments for approximately 85,000 claims. 

Anthem continues to update the reimbursement rates for the new codes and has reprocessed approximately 70,000 of the affected claims at the new reimbursement rates. Anthem expects to finalize the reprocessing of the remaining 15,000 claims by the end of January.

If your practice continues to receive underpayments for the administration of the COVID-19 pediatric vaccine administration claims processed beyond mid-December, please contact the California Medical Association at (888) 401-5911 or economicservices@cmadocs.org.


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