CMS released a set of toolkits for providers, states and insurers to help the health care system prepare to swiftly administer the vaccine once it is available. These resources are designed to increase the number of providers that can administer the vaccine and ensure adequate reimbursement for administering the vaccine in Medicare, while making it clear to private insurers and Medicaid programs their responsibility to cover the vaccine at no charge to beneficiaries. In addition, CMS is taking action to increase reimbursement for any new COVID treatments that are approved by the FDA.
Health care providers will play an important role when a COVID-19 vaccine(s) becomes available. CMS is committed to ensuring you have the necessary tools to respond to the COVID-19 public health emergency. In anticipation of safe and effective COVID-19 vaccines being available in the future, we’re issuing this toolkit to help health care providers prepare to administer vaccines. Because the initial supply of COVID-19 vaccines will be federally purchased, this toolkit primarily focuses on coverage of vaccine administration. Vaccine doses purchased with U.S. taxpayer dollars will be given to the American people at no cost. Providers that participate in the CDC COVID-19 Vaccination Program contractually agree to administer a COVID-19 vaccine regardless of an individual’s ability to pay and regardless of their coverage status, and also may not seek any reimbursement, including through balance billing, from a vaccine recipient. 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 Provider Relief Fund.
We’ll update this toolkit as new information becomes available.
This toolkit includes information to describe:
- How health care providers can enroll in Medicare to bill for administering COVID-19 vaccines when available
- The COVID-19 Vaccine Medicare coding structure
- The Medicare reimbursement strategy for COVID-19 vaccine administration
- How health care providers can bill correctly for administering vaccines, including roster and centralized billing
*New* Additionally, you can find information about a monoclonal antibody infusion for treating COVID-19. During the COVID-19 public health emergency (PHE), Medicare will cover and pay for these infusions the same way it covers and pays for COVID-19 vaccines (when furnished consistent with the EUA).
Table of Contents
- Enrollment for Administering COVID-19 Vaccine Shots
- Coding for COVID-19 Vaccine Shots
- Medicare COVID-19 Vaccine Shot Payment
- Medicare Billing for COVID-19 Vaccine Shot Administration
- SNF: Enforcement Discretion Relating to Certain Pharmacy Billing
- Beneficiary Incentives for COVID-19 Vaccine Shots
- CMS Quality Reporting for COVID-19 Vaccine Shots
- *New* Medicare Monoclonal Antibody COVID-19 Infusion
- Mass Immunizers: Mass immunizers can give flu, pneumococcal, and soon COVID-19 shots, to groups of individuals (like people who live in a retirement community). Mass immunizers can be a traditional provider, like a physician, or a non-traditional provider, like a drug store, public health clinic or senior center. We created the mass immunizer specialty for those providers who wouldn't otherwise be eligible for Medicare enrollment. Mass immunizers must submit all claims as roster billed professional claims.
- Roster billing: This is a way for you to submit multiple claims for flu, pneumococcal, and soon COVID-19 shots. If you’re enrolled as a mass immunizer, you must use roster billing.
- You must administer the same type of shot to 5 or more people on the same date of service. You must bill each type of shot on a separate roster bill. You can’t combine flu, pneumococcal, and COVID-19 shot codes on the same roster bill.
- It’s quick and easy to use roster billing for flu, pneumococcal, and soon COVID-19 shots.
- Centralized Billers: Centralized billing allows mass immunizers to send all roster bill claims for flu, pneumococcal, and soon COVID-19 vaccinations to a single Medicare Administrative Contractor (MAC), Novitas, for payment, regardless of where you administer the shots. Medicare makes geographic payment adjustments based on the locality where you administer the shot. You must submit all centralized biller claims as professional claims on a roster bill.