Medicare COVID-19 Vaccine Shot Payment

On March 15, 2021, CMS updated the Medicare payment rates for COVID-19 vaccine administration. Effective for services furnished on or after March 15, 2021, the new Medicare payment rate for administering a COVID-19 vaccine is approximately $40 to administer each dose of a COVID-19 vaccine. This means that starting on March 15, 2021, for single dose COVID-19 vaccines, Medicare pays approximately $40 for its administration. Starting on March 15, 2021, for COVID-19 vaccines requiring multiple doses, Medicare pays approximately $40 for each dose in the series. This rate reflects updated information about the costs involved in administering the COVID-19 vaccine for different types of providers and suppliers, and the additional resources necessary to ensure the vaccine is administered safely and appropriately. The rate is geographically adjusted based on where the service is furnished.

While CMS generally implements changes to Medicare payment rates for specific services through notice and comment rulemaking, the payment rate changes for these specific services were implemented to respond quickly to new information during the COVID-19 public health emergency.

For COVID-19 vaccine administration services furnished before March 15, 2021, the Medicare payment rate for a single-dose vaccine or for the final dose in a series is $28.39. For a COVID-19 vaccine requiring a series of two or more doses, the payment rate is $16.94 for the initial dose(s) in the series and $28.39 for the final dose in the series. These rates are also geographically adjusted.

Note: these rates do not apply for entities that are paid for preventive vaccines and their administration at reasonable cost, such as Federally Qualified Health Centers, Rural Health Clinics, and Hospital-Based Renal Dialysis Facilities. We also note that, as indicated in the 2021 Medicare Physician Fee Schedule Final Rule, CMS continues to seek additional information from the public for our further consideration as we review and establish payment rates for vaccine administration services during the public health emergency and on a longer term basis.

Get the most current list of billing codes, payment allowances and effective dates.

 

Additional Payment for Administering the Vaccine in the Patient’s Home

Review the infographic (PDF) on Medicare payment for COVID-19 vaccine administration in the home.

Effective June 8, 2021, Medicare’s additional payment amount for administering the COVID-19 vaccine in the home for certain Medicare patients is $35 per dose.

We pay the $35 amount in addition to the standard administration amount (approximately $40 per dose), for a total payment of approximately $75 for a single-dose vaccine or $150 for both doses of a 2-dose vaccine, when administered in the home. We also geographically adjust the additional amount and administration rate based on where you administer the vaccine.

We established this $35 payment amount on a preliminary basis to ensure access to COVID-19 vaccines during the public health emergency. We continue to evaluate the needs of Medicare patients and these policies, and will address them in the future, as needed.

 

When Can I Get the Additional In-Home Payment for Administering the COVID-19 Vaccine?

You can get the additional payment for administering the COVID-19 vaccine in Medicare patients’ homes when either of these situations applies:

  • The patient has difficulty leaving the home to get the vaccine, which could mean any of these:
    • They have a condition, due to an illness or injury, that restricts their ability to leave home without a supportive device or help from a paid or unpaid caregiver
    • They have a condition that makes them more susceptible to contracting a pandemic disease like COVID-19
    • They are generally unable to leave the home, and if they do leave home it requires a considerable and taxing effort
  • The patient is hard-to-reach because they have a disability or face clinical, socioeconomic, or geographical barriers to getting a COVID-19 vaccine in settings other than their home. These patients face challenges that significantly reduce their ability to get vaccinated outside the home, such as challenges with transportation, communication, or caregiving.

Unlike the requirements under the Medicare home health benefit, you or another allowed practitioner don’t need to certify that the Medicare patient is homebound, but you must document in the patient’s medical record their clinical status or the barriers they face to getting the vaccine outside the home.

 

What Locations Qualify for the Additional In-Home Payment?

Many types of locations can qualify as a Medicare patient’s home for the additional in-home payment amount, such as:

  • A private residence
  • Temporary lodging (for example, a hotel or motel, campground, hostel, or homeless shelter)
  • An apartment in an apartment complex or a unit in an assisted living facility or group home
  • A Medicare patient’s home that’s made provider-based to a hospital during the COVID-19 public health emergency

These locations don’t qualify as a home for the additional payment amount:

  • Communal spaces of a multi-unit living arrangement
  • Hospitals, Medicare skilled nursing facilities (SNFs), and Medicaid nursing facilities, regardless of whether they are the patient’s permanent residence
  • Assisted living facilities participating in the CDC’s Pharmacy Partnership for Long-Term Care Program when their residents are vaccinated through this program

 

What Other Restrictions Apply?

Medicare only pays the additional amount for administering the COVID-19 vaccine in the home if the sole purpose of the visit is to administer a COVID-19 vaccine. Medicare doesn’t pay the additional amount if you provide another Medicare service in the same home on the same date. In those situations, Medicare pays for administering the COVID-19 vaccine at the standard amount (approximately $40 per dose).

If you administer the COVID-19 vaccine to more than 1 Medicare patient in a single home on the same day, Medicare pays:

  • The additional payment amount of approximately $35 only once per date of service in that home
  • Approximately $40 to administer each dose of the COVID-19 vaccine

For example, if you administer a single-dose vaccine on the same date to 2 Medicare patients in the same home, Medicare pays approximately $115 ($35 for the in-home vaccine administration, plus 2 x $40 for each dose of the COVID-19 vaccine).

Page Last Modified:
06/09/2021 09:05 AM