COVID-19 Vaccines and Monoclonal Antibodies

Medicare Part B Payment for COVID-19 Vaccines and Certain Monoclonal Antibodies during the Public Health Emergency

CMS has released a set of toolkits for providers, states and insurers to help the health care system prepare and assist in swiftly administering these products once they become available.  These resources are designed to increase the number of providers that can administer the products and ensure adequate reimbursement for administration in Medicare, while making it clear to private insurers and Medicaid programs their responsibility to cover these products at no charge to beneficiaries.  This webpage provides the payment allowances and other related information for these products.  For more information, review the COVID-19 provider toolkit.

Payment Allowances and Effective Dates for COVID-19 Vaccines and their Administration During the Public Health Emergency: (DOS = Date of Service, TBD = To Be Determined)

* Since we anticipate that providers, initially, will not incur a cost for the product, CMS will update the payment allowance at a later date.  Providers should not bill for the product if they received it for free.

** These rates will also be geographically adjusted for many providers. For providers and suppliers with payments that are geographically adjusted by the methodology used by the Medicare Physician Fee Schedule (MPFS), files with the geographically adjusted payment rates for COVID-19 vaccine administration are included in the “Additional Resources” section below. Certain settings utilize other payment methodologies, such as payment based on reasonable costs.

*** Johnson & Johnson COVID-19 Vaccine

Payment Allowances and Effective Dates for COVID-19 Monoclonal Antibodies and their Administration During the Public Health Emergency:

* Since we anticipate that providers, initially, will not incur a cost for the product, CMS will update the payment allowance at a later date.  Providers should not bill for the product if they received it for free.

*** Medicare will pay a rate of $309.60 for many providers. These rates will also be geographically adjusted for many providers.  For providers and suppliers with payments that are geographically adjusted by the methodology used by the Medicare Physician Fee Schedule (MPFS), files with the geographically adjusted payment rates for monoclonal antibody administration are included in the “Additional Resources” section below. Certain settings utilize other payment methodologies, such as payment based on reasonable costs.

****On April 16, 2021, the FDA revoked the EUA that allowed for the investigational monoclonal antibody therapy bamlanivimab, when administered alone, to be used for the treatment of mild-to-moderate COVID-19 in adults and certain pediatric patients. Due to this revocation, Medicare will not pay for claims with HCPCS codes M0239 or Q0239 with dates of service after 4/16/2021.

Additional Resources:

Following links contain helpful information for providers. Product NDCs can be found in the EUA Fact Sheet for Healthcare Providers and can be used to identify the appropriate HCPCS codes for each product and its administration.  NDC - HCPCS crosswalk is available in CMS ASP crosswalk zip folder. Long, medium, and short descriptors of COVID-19 CPT codes are available from AMA website.

Medicare Monoclonal Antibody COVID-19 Infusion Program Instruction

Covid-19 NDC-HCPCS crosswalk

COVID-19 Vaccination Resources at CDC

COVID-19 CPT vaccine and immunization codes - AMA

Quick reference guide to the coding structure for Covid-19 vaccine CPT reporting

Bamlanivimab Emergency Use Authorization

Casirivimab and imdevimab Emergency Use Authorization (ZIP)

Bamlanivimab and etesevimab Emergency Use Authorization

Pfizer-BioNTech COVID-19 Vaccine Emergency Use Authorization

Moderna COVID-19 Vaccine Emergency Use Authorization (PDF)

Janssen COVID-19 Vaccine Emergency Use Authorization

Fact Sheet for Healthcare Providers - Emergency Use Authorization of bamlanivimab

Fact Sheet for Healthcare Providers - Emergency Use Authorization of casirivimab and imdevimab

Fact Sheet for Healthcare Providers - Emergency Use Authorization of bamlanivimab and etesevimab

Fact Sheet for Healthcare Providers - Emergency Use Authorization of Pfizer-BioNTech COVID-19 Vaccine

Fact Sheet for Healthcare Providers - Emergency Use Authorization of Moderna COVID-19 Vaccine

Fact Sheet for Healthcare Providers - Emergency Use Authorization of Janssen COVID-19 Vaccine

Information about Public Health Emergency

COVID-19 Vaccination Training Programs and Reference Materials for Healthcare Professionals

2020 Geographically-adjusted Payment Rates for Monoclonal Antibody Administration (for Providers & Suppliers Paid MPFS-Adjusted Rates) (ZIP) 

2021 Geographically-adjusted Payment Rates for Monoclonal Antibody Administration (for Providers & Suppliers Paid MPFS-Adjusted Rates) (ZIP) *Updated February 16, 2021 for addition of bamlanivimab and etesevimab*

2020 Geographically-adjusted Payment Rates for Covid-19 Vaccine Administration (for Providers & Suppliers Paid MPFS-Adjusted Rates) (ZIP) 

Jan - March 2021 Geographically-adjusted Payment Rates for Covid-19 Vaccine Administration (for Providers & Suppliers Paid MPFS-Adjusted Rates) (ZIP)  *Updated February 16, 2021 for addition of the COVID-19 Janssen Vaccine* [For claims with dates of service of 1/1/2021 through 3/14/2021]

March - Dec 2021 Geographically-adjusted Payment Rates for Covid-19 Vaccine Administration (for Providers & Suppliers Paid MPFS-Adjusted Rates) (ZIP) *Updated 3/15/2021 to account for change in payment rate* [For claims with dates of service 3/15/2021 – 12/31/2021]