Login
Early Monday morning, November 9th, Pfizer announced some positive results regarding their COVID-19 Vaccine they are developing with BioNTech. This vaccine candidate is a two-dose series. The phase III clinical trials involved over 40,000 patients. There is some data in the press release that based on exposing patients who received the vaccine to COVID-19, the data shows the vaccine is at least 90% effective at least 1 week after the 2nd dose. While this is really great initial data, there are a number of unknowns such as if future booster doses will be needed.
This positive news quickly moved across the country and the stock market responded with a major one-day increase. There are a number of candidates related to the COVID-19 vaccine and based on the current data, it appears that 3-4 companies might have COVID-19 vaccines available in the next few months. All vaccine candidates will need to receive final FDA approval prior to being available. Unlike other vaccines, the initial distribution will be coordinated with the government for allocation through operation Warp speed. The government has advanced and purchased hundreds of millions of doses of the COVID-19 vaccine from a few manufacturers (including Pfizer). This purchase and distribution by the government is different from previous vaccines due to the importance and significant impact of the pandemic.
Normally, a Pediatric practice would order a vaccine directly from the manufacturer, receive the vaccine, store the vaccine, need to pay for the vaccine order within 75-90 days of the delivery date, administer the vaccine to the patient, bill the patient’s insurance, and collect payment from the insurance company and/or patient. For new vaccines, there are other steps including a CPT code being created, insurance companies updating their fee schedules and insurance claim systems. The amount of work and effort required by Pediatric Practice staff members to update a new vaccine in an EHR system varies greatly depending on the EHR system and their associated services provided to the practice. The Physician Xpress team maintains a vaccine database within the PediatricXpress system which includes lot numbers and many other details in a manner that minimizes the work required by the Pediatric practices. Pediatric Practice users can record inventory for each vaccine lot, maintain their inventory and see which patients were administered each lot number. The Physician Xpress team provides the CPT code for each vaccine so when selected by the staff the proper vaccine CPT code and associated vaccine administration code is billed to the insurance of the patient. The AMA provided on November 10th the new CPT Codes for the Pfizer (91300) and Mcderma (91301) COVID-19 Vaccines as well as the associated vaccine administration codes (0001A – first admin code for Pfizer COVID vaccine, 0002A – 2nd Admin code for Pfizer COVID vaccine, 0011A – first admin code for Mcderma COVID vaccine, 0012A – second admin code for Mcderma vaccine). These CPT codes are already loaded into the PediatricXpress system to be ready for Pediatric Practices that might provide this vaccine in the future. The Physician Xpress team submits claims and collects from the insurance companies as well as patients. It is important that each practice be aware of the profitability of each vaccine (amount of payment collected over the cost of the vaccine). The Physician Xpress team provides an annual report of annual profitability for the practice (overall and breakdown by vaccine and by insurance company).
Since the COVID-19 vaccine initial distribution is directly to the government, it is still unknown if/when Pediatric offices can order directly from the manufacturers and/or distributors. There are a number of details related to the distribution and administration of the COVID-19 vaccine that should become available when the first vaccine is approved by the FDA.
We would anticipate that COVID-19 vaccines will eventually become available to Pediatric offices after the initial distribution phase. We will continue to monitor this closely and update the PediatricXpress system and processes so Pediatric practices can focus on giving vaccines without the worry and burden of maintaining many of the details associated with inventory and medical billing.
