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 up to date list of billing codes, payment allowances and effective dates.

Page Last Modified:
04/02/2021 01:45 PM