Medicare COVID-19 Vaccine Shot Payment

Medicare Payment Rates

Vaccine Type Date Vaccine Administered & Manufacturer Medicare Payment Rates for Administering Vaccines 
COVID-19 vaccines On or after March 15, 2021
  • Approximately $40 for single-dose vaccines
  • For vaccines requiring multiple doses, approximately $40 for each dose in the series, including any additional doses and booster doses
Additional doses of the COVID-19 vaccine administered to immunocompromised patients On or after August 12, 2021
First booster doses administered to certain patients On or after:
  • September 22, 2021 (Pfizer-BioNTech)
  • October 20, 2021 (Moderna)
First booster doses administered to all patients 18 years and older On or after:
  • October 20, 2021 (Janssen)
  • November 19, 2021 (Pfizer-BioNTech)
  • November 19, 2021 (Moderna)
  • October 19, 2022 (Novavax)
First booster doses administered to all patients 16 years and older On or after December 9, 2021 (Pfizer-BioNTech)
Pediatric doses administered to patients 5–11 years old On or after October 29, 2021 (Pfizer-BioNTech)  
First booster doses administered to all patients 12 years and older On or after January 3, 2022 (Pfizer-BioNTech)
Pediatric third doses for 5–11-year-old solid organ transplant patients or patients with a similar level of immunocompromise On or after January 3, 2022 (Pfizer-BioNTech)
Second booster doses administered to all patients 50 years and older and certain immunocompromised patients 12 years and older On or after March 29, 2022 (Pfizer-BioNTech)
Second booster doses administered to all patients 50 years and older and certain immunocompromised patients 18 years and older On or after March 29, 2022 (Moderna)
Bivalent booster doses (updated COVID-19 vaccines) administered to all patients 12 years and older On or after August 31, 2022 (Pfizer BioNTech)

Bivalent booster doses (updated COVID-19 vaccines) administered to all patients 511 years old

On or after October 12, 2022 (Pfizer-BioNTech)

Bivalent booster doses (updated COVID-19 vaccines) administered to all patients 18 years and older On or after August 31, 2022 (Moderna)

Bivalent booster doses (updated COVID-19 vaccines) administered to all patients 617 years old

On or after October 12, 2022 (Moderna)

First pediatric booster doses administered to all patients 5-11 years old On or after May 17, 2022 (Pfizer-BioNTech)
Pediatric doses administered to patients 6 months - 17 years old On or after June 17, 2022 (Moderna)
Pediatric doses administered to patients 6 months - 4 years old On or after June 17, 2022 (Pfizer-BioNTech)
COVID-19 vaccines Before March 15, 2021
  • $28.39 for single-dose vaccines
  • For vaccines requiring a series of 2 or more doses:
    • $16.94 for the initial dose(s) in the series
    • $28.39 for the final dose in the series 


These rates reflect updated information about the costs involved in administering the COVID-19 vaccine for different types of providers and suppliers and the additional resources you need to safely and appropriately administer the vaccine.

CMS will continue to pay these rates for administering COVID-19 vaccines through the end of the calendar year in which the current emergency use authorization (EUA) declaration for COVID-19 drugs and biologicals ends. During this interim time, we’ll maintain the administration payment amounts when you administer COVID-19 vaccines in health care settings and in the home, as described below.

Effective January 1 of the year following the year in which the EUA declaration for COVID-19 drugs and biologicals ends, we’ll set the payment rate for administering COVID-19 vaccines to align with the payment rate for administering other Part B preventive vaccines.

For all COVID-19 vaccine payment rates listed above, we also geographically adjust the rates based on where you administer the vaccine. Starting January 1, 2023, we’ll also annually update the COVID-19 vaccine payment rates to reflect changes in costs related to administering preventive vaccines.

Note:

These rates don’t apply if Medicare pays you for preventive vaccines and their administration at reasonable cost (for example, Federally Qualified Health Centers, Rural Health Clinics, and Hospital-based Renal Dialysis Facilities). 


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

Timeline
  • March 15, 2021: CMS updated the Medicare payment rates for administering COVID-19 vaccines
  • August 12, 2021: FDA updated the EUAs for the Pfizer-BioNTech (PDF) and Moderna (PDF) COVID-19 vaccines to authorize the use of an additional dose for immunocompromised patients
  • September 22, 2021: FDA amended the Pfizer-BioNTech EUA to authorize the use of a single booster dose for certain populations after completion of primary vaccination with any FDA-authorized or approved COVID-19 vaccine
  • October 20, 2021: FDA amended the Moderna EUA to authorize the use of first booster doses for certain populations after completion of primary vaccination with any FDA-authorized or approved COVID-19 vaccine
  • October 20, 2021: FDA amended the Janssen EUA to authorize the use of first booster doses after completion of primary vaccination with any FDA-authorized or approved COVID-19 vaccine for all patients 18 years and older
  • October 29, 2021: FDA updated the Pfizer-BioNTech vaccine EUA to authorize a pediatric dose for patients 5–11 years old
  • November 19, 2021: FDA amended the Pfizer-BioNTech and Moderna EUAs to authorize the use of first booster doses after completion of primary vaccination with any FDA-authorized or approved COVID-19 vaccine for all patients 18 years and older
  • December 9, 2021: FDA amended the Pfizer-BioNTech EUA to authorize the use of first booster doses after completion of primary vaccination with any FDA-authorized or approved COVID-19 vaccine for all patients 16 years and older
  • January 3, 2022: FDA amended the Pfizer-BioNTech EUA to authorize the use of first booster doses for all patients 12 years and older and a third pediatric dose for 5–11-year-old solid organ transplant patients or patients with a similar level of immunocompromise
  • March 29, 2022: FDA amended the Pfizer-BioNTech EUA to authorize the use of second booster doses for all patients 50 years and older and certain immunocompromised patients 12 years and older, and they amended the Moderna EUA to authorize the use of second booster doses for all patients 50 years and older and certain immunocompromised patients 18 years and older
  • May 17, 2022: FDA amended the Pfizer-BioNTech EUA to authorize the use of a single booster pediatric dose (orange cap) for all patients 5-11 years old who have completed a primary series with the Pfizer-BioNTech vaccine
  • June 17, 2022: FDA amended the Moderna EUA to authorize use for all patients 6 months – 17 years old, and amended the Pfizer-BioNTech EUA to authorize use for all patients 6 months – 4 years old
  • July 13, 2022: FDA issued an EUA for Novavax COVID-19 vaccine, Adjuvanted to authorize use for all patients 18 years and older
  • August 19, 2022: FDA amended the Novavax COVID-19 vaccine, Adjuvanted EUA to authorize use for all patients 12–17 years old
  • August 31, 2022: FDA amended the Pfizer-BioNTech EUA to authorize bivalent booster doses (updated COVID-19 vaccines) for patients 12 years and older and amended the Moderna EUA to authorize bivalent booster doses (updated COVID-19 vaccines) for patients 18 years and older
  • October 12, 2022: FDA amended the Pfizer-BioNTech EUA to authorize bivalent booster doses (updated COVID-19 vaccines) for patients 5-11 years old and amended the Moderna EUA to authorize bivalent booster doses (updated COVID-19 vaccines) for patients 6-17 years old
  • October 19, 2022: FDA amended the Novavax COVID-19 vaccine, Adjuvanted EUA to authorize the use of first booster doses for patients 18 years and older:
    • For whom an FDA-authorized bivalent (updated) booster isn’t accessible or clinically appropriate
    • Who choose to get the Novavax booster because they wouldn’t otherwise get a COVID-19 booster

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

View the infographic (English (PDF)) (Spanish (PDF)) 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 approximately $35 per dose. This payment also applies when you administer any of the additional or booster doses listed in the Medicare Payment Rates table. We’ll continue this additional payment through CY 2023.

Medicare will pay approximately $35 in addition to the standard administration amount (approximately $40 per COVID-19 vaccine dose), for a total payment of approximately $75 for a vaccine dose administered in a patient's home. We also geographically adjust the additional amount and administration rate based on where you administer the vaccine. Starting January 1, 2023, we’ll also annually update the additional in-home payment rate for administering the COVID-19 vaccine to reflect changes in costs related to administering preventive vaccines.

We established this payment amount of approximately $35 on a preliminary basis to ensure access to COVID-19 vaccines during the PHE. We continue to evaluate the needs of Medicare patients and these policies, and we'll 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, group home, or non-Medicaid nursing facility
  • A Medicare patient’s home that’s made provider-based to a hospital during the COVID-19 PHE
  • Effective August 24, 2021, communal spaces of a multi-unit or communal living arrangement
  • Effective August 24, 2021, assisted living facilities participating in the CDC’s Pharmacy Partnership for Long-Term Care Program when their residents are vaccinated through this program
Note:

In response to the COVID-19 PHE, CMS issued several 1135 waivers (PDF) to let hospitals provide services, including administering vaccines, in temporary expansion sites. CMS doesn’t pay for preventive vaccine administration under the Outpatient Prospective Payment System (OPPS) or the Physician Fee Schedule (PFS). So, we pay hospitals to administer COVID-19 vaccines at the same rate even in a non-excepted off-campus provider-based department (PBD), including a patient’s home that is made provider-based to a hospital during the COVID-19 PHE.

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

  • Prior to August 24, 2021, communal spaces of a multi-unit living or communal arrangement
  • Hospitals (except when the Medicare patient’s home has been made provider-based to a hospital during the COVID-19 PHE)
  • Medicare skilled nursing facilities (SNFs) and Medicaid nursing facilities, regardless of whether they’re the patient’s permanent residence

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 in the same multi-unit or communal living arrangement on the same day, Medicare pays:

  • Approximately $40 to administer each dose of the COVID-19 vaccine, including additional doses and booster doses
  • For dates of service between June 8, 2021 and August 24, 2021, Medicare pays the additional payment amount of approximately $35 only once per date of service in that home regardless of how many Medicare patients get the vaccine
  • Starting August 24, 2021, Medicare pays the additional payment amount (approximately $35 per dose administered), for up to a maximum of 5 vaccine administration services per home unit or communal space within a single group living location
    • You can bill for up to 5 vaccine administration services only when fewer than 10 Medicare patients get a COVID-19 vaccine dose on the same day at the same group living location
    • When 10 or more Medicare patients get a COVID-19 vaccine dose at a group living location on the same day, you can only bill for the additional payment once per home (whether the home is an individual living unit or a communal space)

Examples:

Date COVID-19 Vaccines Administered (All on the Same Date) Number of Patients Who Got the Vaccine Medicare Pays (Approximately) Calculation
Between June 8, 2021, and August 24, 2021 2 patients in the same home $115 $35 in-home additional payment + (2 x $40 for each COVID-19 vaccine dose) = $115
On or after August 24, 2021 2 patients in the same home $150 (2 x $35 in-home additional payment) + (2 x $40 for each COVID -19 vaccine dose) = $150
On or after August 24, 2021 9 patients in the same home1 $535 (5 x $35 in-home additional payment) + (9 x $40 for each COVID -19 vaccine dose) = $535
On or after August 24, 2021 12 patients in the same home2 $515 (1 x $35 in-home additional payment)3 + (12 x $40 for each COVID -19 vaccine dose) = $515
On or after August 24, 2021 12 patients in 12 different homes4 $900 (12 x $35 in-home additional payment) + (12 x $40) = $900
On or after August 24, 2021 5 patients in a communal space in a group living setting and 3 patients in their individual rooms $600 (5 x each COVID -19 vaccine dose $35 in-home additional payment for the single communal space) + (3 x $35 in-home additional payment for each of the individual homes) + (8 x $40 for each COVID -19 vaccine dose) = $600

1Includes a communal space in a group living situation
2Could be an individual living unit or a communal space in a group living situation
3You can only bill for 1 home add-on payment in this situation because you vaccinated 10 or more Medicare patients at the same group living location on the same date
4In other words, each vaccine administered in a distinct individual living unit or communal space of a group living situation
 

Page Last Modified:
12/02/2022 11:26 AM