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)

CPT Code	CPT Short Descriptor	Labeler Name	Vaccine/Procedure Name	National Payment Allowance Effective for Claims with DOS on or after 03/15/2021	National Payment Allowance Effective for Claims with DOS through 03/14/2021	Effective Dates
91300	SARSCOV2 VAC 30MCG/0.3ML IM	Pfizer	Pfizer-Biontech Covid-19 Vaccine	$0.010^[1]	$0.010^[1]	12/11/2020 – TBD
0001A	ADM SARSCOV2 30MCG/0.3ML 1ST	Pfizer	Pfizer-Biontech Covid-19 Vaccine Administration – First Dose	$40.000^[2]	$16.940^[2]	12/11/2020 – TBD
0002A	ADM SARSCOV2 30MCG/0.3ML 2ND	Pfizer	Pfizer-Biontech Covid-19 Vaccine Administration – Second Dose	$40.000^[2]	$28.390^[2]	12/11/2020 – TBD
91301	SARSCOV2 VAC 100MCG/0.5ML IM	Moderna	Moderna Covid-19 Vaccine	$0.010^[1]	$0.010^[1]	12/18/2020 – TBD
0011A	ADM SARSCOV2 100MCG/0.5ML1ST	Moderna	Moderna Covid-19 Vaccine Administration – First Dose	$40.000^[2]	$16.940^[2]	12/18/2020 – TBD
0012A	ADM SARSCOV2 100MCG/0.5ML2ND	Moderna	Moderna Covid-19 Vaccine Administration – Second Dose	$40.000^[2]	$28.390^[2]	12/18/2020 – TBD
91302	SARSCOV2 VAC 5X10^10VP/.5MLIM	AstraZeneca	AstraZeneca Covid-19 Vaccine	$0.010^[1]	Code not active during this time	xx/xx/xxxx – TBD
0021A	ADM SARSCOV2 5X10^10VP/.5ML 1	AstraZeneca	AstraZeneca Covid-19 Vaccine Administration – First Dose	$40.000^[2]	Code not active during this time	xx/xx/xxxx – TBD
0022A	ADM SARSCOV2 5X10^10VP/.5ML 2	AstraZeneca	AstraZeneca Covid-19 Vaccine Administration – Second Dose	$40.000^[2]	Code not active during this time	xx/xx/xxxx – TBD
91303	SARSCOV2 VAC AD26 .5ML IM	Janssen	Janssen Covid-19 Vaccine[3]***	$0.010^[1]	$0.010^[1]	02/27/2021 – TBD
0031A	ADM SARSCOV2 VAC AD26 .5ML	Janssen	Janssen Covid-19 Vaccine Administration[3]***	$40.000^[2]	$28.390^[2]	02/27/2021 – TBD
91304	SARSCOV2 VAC 5MCG/0.5ML IM	Novavax	Novavax Covid-19 Vaccine	$0.010^[1]	Code not active during this time	xx/xx/xxxx – TBD
0041A	ADM SARSCOV2 5MCG/0.5ML 1ST	Novavax	Novavax Covid-19 Vaccine Administration – First Dose	$40.000^[2]	Code not active during this time	xx/xx/xxxx – TBD
0042A	ADM SARSCOV2 5MCG/0.5ML 2ND	Novavax	Novavax Covid-19 Vaccine Administration – Second Dose	$40.000^[2]	Code not active during this time	xx/xx/xxxx – TBD

^[1] 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.

^[2] 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.

^[3] Johnson & Johnson COVID-19 Vaccine

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

HCPCS Code	CPT Short Descriptor	Labeler Name	Vaccine/Procedure Name	National Payment Allowance Effective for Claims with DOS on or after 05/6/2021	National Payment Allowance Effective for Claims with DOS through 05/5/2021	Effective Dates
Q0239	Bamlanivimab-xxxx	Eli Lilly	Injection, bamlanivimab, 700 mg	Code not active during this time period	$0.010^[1]	11/10/2020 – 04/16/2021^[4]
M0239	Bamlanivimab-xxxx infusion	Eli Lilly	Intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoring	Code not active during this time period	$309.600^[3]	11/10/2020 – 04/16/2021^[4]
Q0243	Casirivimab and imdevimab	Regeneron	Injection, casirivimab and imdevimab, 2400 mg	$0.010^[1]	$0.010^[1]	11/21/2020 – TBD
M0243	Casirivi and imdevi infusion	Regeneron	Intravenous infusion, casirivimab and imdevimab includes infusion and post administration monitoring	$450.00^[3]	$309.600^[3]	11/21/2020 – TBD
M0244	Casirivi and imdevi infus hm	Regeneron	Intravenous infusion, casirivimab and imdevimab includes infusion and post administration monitoring in the home or residence; this includes a beneficiary’s home that has been made provider-based to the hospital during the covid-19 public health emergency.	$750.00^[3]	Code not active during this time period	05/06/2021 – TBD
Q0245	Bamlanivimab and etesevima	Eli Lilly	Injection, bamlanivimab and etesevimab, 2100 mg	$0.010^[1]	$0.010^[1]	02/09/2021 – TBD
M0245	Bamlan and etesev infusion	Eli Lilly	intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring	$450.00^[3]	$309.600^[3]	02/09/2021 – TBD
M0246	Bamlan and etesev infus home	Eli Lilly	Intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring in the home or residence; this includes a beneficiary’s home that has been made provider-based to the hospital during the covid-19 public health emergency.	$750.00^[3]	Code not active during this time period	05/06/2021 – TBD

^[3] These rates will 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.

^[4]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