Medicare COVID-19 Vaccine Shot Payment

On March 15, 2021, CMS updated the Medicare payment rates for administering COVID-19 vaccines. For COVID-19 vaccines administered on or after March 15, 2021, Medicare payment rates for administering the vaccines are:

  • Approximately $40 for single-dose vaccines
  • For vaccines requiring multiple doses, approximately $40 for each 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.

We generally implement changes to Medicare payment rates for specific services through notice and comment rulemaking. In this case, however, we implemented the payment rate changes for these specific services to respond quickly to new information during the COVID-19 public health emergency (PHE).

For COVID-19 vaccines administered before March 15, 2021, the Medicare payment rates are:

  • $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 

For all COVID-19 vaccine payment rates listed above, we also geographically adjust the rates based on where you administer the vaccine.

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). Also, as indicated in the 2021 Medicare Physician Fee Schedule Final Rule, we continue to seek additional information from the public for further consideration as we review and establish payment rates for vaccine administration services during the PHE 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

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 $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 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 or group home
  • A Medicare patient’s home that’s made provider-based to a hospital during the COVID-19 PHE
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:

  • Communal spaces of a multi-unit living arrangement
  • Hospitals (except when the Medicare patient’s home has been made provider-based to a hospital during the COVID-10 PHE)
  • Medicare skilled nursing facilities (SNFs) and Medicaid nursing facilities, regardless of whether they’re 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
Note:

The CDC’s Pharmacy Partnership for Long-Term Care Program ended on April 23, 2021. An assisted living facility may qualify as a patient’s home for the additional in-home payment if these apply:

  • The facility no longer participates in the program
  • The facility meets all other criteria for the additional in-home payment

 

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:
07/30/2021 01:46 PM