Anthem continues to reprocess more than $2.8 million in pediatric vaccine claim underpayments

January 20, 2022

Anthem Blue Cross continues to reprocess more than $2.8 million in underpayments tied to the COVID-19 vaccine for 5–11-year-olds.  As previously reported, the California Medical Association (CMA) had received reports that 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. CMA brought the issue to Anthem’s attention and urged the payor to address the underpayments as soon as possible to prevent further disruption to the rollout of the pediatric vaccine.

Anthem had advised CMA 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. This resulted in underpayments of approximately 85,000 claims. 

Anthem has now updated the reimbursement rates for the new codes and 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 CMA at (888) 401-5911 or economicservices@cmadocs.org.



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