Medicare Billing for COVID-19 Vaccine Shot Administration

There’s No Out-of-Pocket Cost for Your Patients

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:

How to Bill for COVID-19 Shot Administration

  • You must be a Medicare-enrolled provider to bill Medicare for administering COVID-19 vaccines to Medicare patients. Learn more about Enrollment for Administering COVID-19 Vaccines.
  • You can bill on single claims for COVID-19 shot administration, or submit claims on a roster bill for multiple patients at one time.
  • When COVID-19 vaccine doses are provided by the government without charge, only bill for the vaccine administration. Don’t include the vaccine codes on the claim when the vaccines are free.
    • You must administer the vaccine with no out-of-pocket cost to your patients for the vaccine or administration of the vaccine.
    • If you want to administer the vaccine for free, you don’t have to submit a claim to Medicare, Medicaid, or another insurer. But, you can’t charge your patients or ask them to submit a claim to Medicare or another insurer.
    • If you get government funding to help pay for administering the COVID-19 vaccine (like a federal or state grant), you can still submit a claim to Medicare for administering the vaccine.
  • If you participate in a Medicare Advantage Plan, submit your COVID-19 claims to Original Medicare for all patients enrolled in Medicare Advantage in 2020 and 2021.

 

How to submit a claim if you’re a Medicare Advantage Plan contracted provider

If you are a Medicare Advantage contracted provider, submit claims for administering COVID-19 vaccines to Original Medicare through your MAC as outlined in the institutional and professional instructions below.

 

Medicare and other types of insurance coverage

If your patients only have Part A Medicare coverage, ask if they have other medical insurance to cover Part B services, like vaccine administration.

If your patients are enrolled in a Medicare Advantage Plan (Part C), they have coverage for Part B services. Submit those COVID-19 administration claims to Original Medicare for all patients enrolled in Medicare Advantage in 2020 and 2021.

Use your patients’ Medicare Beneficiary Identifier (MBI) to bill Original Medicare.

  • Ask your patients for their Original Medicare card. Even if they are enrolled in a Medicare Advantage Plan, they have a red, white, and blue Medicare card with an MBI.
  • If your patients don’t have their Original Medicare card or don’t know their MBI, use the MBI look-up tool in your MAC’s secure portal (PDF) – you must have your patient’s first name, last name, date of birth, and social security number. Even if your patients are enrolled in Medicare Advantage Plans, you can look up their MBIs.

 

Coordination of benefits and Medicare as secondary payer

Before you submit a claim to Medicare for administering COVID-19 vaccines, you must determine if your Medicare patients have other insurance, such as employer health insurance, or coverage through a spouse’s employer health insurance and if Medicare pays first or second.

You must gather information both from patients with Original Medicare and from patients enrolled in Medicare Advantage plans. All providers administering COVID 19 vaccines should verify insurance information. To verify insurance information, you can:

 

How to submit institutional claims

If you use roster billing for institutional claims, you must administer shots to at least 5 patients on the same date, unless the institution is an inpatient hospital.  You can also submit individual claims.

What are valid types of bills for roster billing?

  • 12X, Hospital Inpatient**
  • 13X, Hospital Outpatient**
  • 22X, Skilled Nursing Facility (SNF) covered Part A stay (paid under Part B) & Inpatient Part B
  • 23X, SNF Outpatient
  • 34X, Home Health (Part B Only)
  • 72X, Independent and Hospital-based Renal Dialysis Facility
  • 75X, Comprehensive Outpatient Rehabilitation Facility
  • 81X, Hospice (Non-hospital)
  • 82X, Hospice (Hospital)
  • 85X, Critical Access Hospital

** For hospitalized patients, Medicare pays for the COVID-19 shots separately from the Diagnosis-Related Group rate and disallows billing them on 11X.

 

How to submit an institutional claim

Electronic Claims

Use Direct Data Entry:

  1. Option 02, Claims Attachment
  2. Option 87, Roster Bill Entry

Paper Claims

  1. CMS-1450 (UB-04)
  2. Roster form for patients (contact your MAC) for this form)

 

How to submit professional claims

If you use roster billing for professional claims, you must administer the same type of shot to 5 or more people on the same date of service. You can also submit individual claims.

How to submit a professional claim

Electronic Claims

Use PC ACE billing software to submit directly to your MAC. Download this free billing software (PDF) from your MAC and electronically submit professional claim roster billing.

Paper Claims

  1. Health Insurance Claim Form (CMS-1500) (PDF)
  2. Roster form for patients (contact your MAC) for this form)

 

How to submit a centralized bill

If you’re enrolled as a centralized biller, you can submit a professional claim to Novitas, regardless of where you administered the shots

Page Last Modified:
04/19/2021 11:56 AM