This page is for health care providers.
If you're a person with Medicare, learn more about your Medicare coverage for COVID-19 vaccines.
Each state has its own plan for deciding who they’ll vaccinate first and how residents can get vaccines. Learn more about COVID-19 vaccines progress, including how to get a vaccine in your state.
The CDC issued a Health Alert, about the CDC and FDA’s recommended pause in the use of the J&J COVID-19 vaccine, in part, to ensure that the health care provider community is aware of the potential for adverse events and can provide proper management due to the unique treatment required with this type of blood clot. This alert includes specific recommendations for clinicians.
CMS released a set of toolkits for providers, states and insurers designed to:
- Help the health care system quickly administer vaccines as they're available
- Increase the number of providers who can administer the vaccine
- Ensure adequate Medicare payment for administering the vaccine
- Ensure private insurers and Medicaid programs understand their responsibility to cover the vaccine at no cost to patients
We're also taking action to increase payment for any new FDA-approved COVID-19 treatments.
Health care providers play an important role and we're committed to ensuring you have the necessary tools to respond to the COVID-19 public health emergency (PHE). Because the federal government purchased the initial supply of COVID-19 vaccines, this toolkit primarily focuses on coverage for administering the vaccine. Americans can get vaccines purchased with U.S. taxpayer dollars at no cost.
If you participate in the CDC COVID-19 Vaccination Program, you must:
- Administer the vaccine with no out-of-pocket cost to your patients for the vaccine or administration of the vaccine
- Vaccinate everyone, including the uninsured, regardless of coverage or network status
You also can’t:
- Balance bill for COVID-19 vaccinations
- Charge your patients for an office visit or other fee if COVID-19 vaccination is the only medical service given
- Require additional medical or other services during the visit as a condition for getting a COVID-19 vaccination
Report any potential violations of these requirements to the HHS Office of the Inspector General:
- Call 1-800-HHS-TIPS
- Submit an online complaint
Providers who have questions about billing or reimbursement of vaccine administration for patients covered by private insurance or Medicaid should contact the respective health plan or state Medicaid agency. People without health insurance or whose insurance does not provide coverage of the vaccine can also get COVID-19 vaccine at no cost. Providers administering the vaccine to people without health insurance or whose insurance does not provide coverage of the vaccine can request reimbursement for the administration of the COVID-19 vaccine through the Health Resources & Services Administration (HRSA) COVID-19 Uninsured Program.
What’s in the Toolkit?
We’ll update this toolkit as new information becomes available.
This toolkit includes information to describe:
- How you can enroll in Medicare to bill for administering COVID-19 vaccines
- The COVID-19 vaccine Medicare coding structure
- Medicare payment rates for administering COVID-19 vaccines
- How to bill correctly for administering vaccines, including roster and centralized billing
- Monoclonal antibody infusion for treating COVID-19
- New COVID-19 Treatments Add-on Payment (NCTAP)