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 or HCPCS Code	CPT or HCPCS 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
0003A	ADM SARSCOV2 30MCG/0.3ML 3RD	Pfizer	Pfizer-BioNTech Covid-19 Vaccine Administration – Third Dose	$40.000^[2]	Code not active during this time	08/12/2021 – TBD
0004A	ADM SARSCOV2 30MCG/0.3ML BST	Pfizer	Pfizer-BioNTech Covid-19 Vaccine Administration – Booster	$40.000^[2]	Code not active during this time	09/22/2021 – 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
0013A	ADM SARSCOV2 100MCG/0.5ML3RD	Moderna	Moderna Covid-19 Vaccine Administration – Third Dose	$40.000^[2]	Code not active during this time	08/12/2021 – 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
91305	SARSCOV2 VAC 30 MCG TRS-SUCR	Pfizer	Pfizer-BioNTech Covid-19 Vaccine (Ready to Use)	$0.010^[1]	Code not active during this time	xx/xx/xxxx – TBD
0051A	ADM SARSCV2 30MCG TRS-SUCR 1	Pfizer	Pfizer-BioNTech Covid-19 Vaccine (Ready to Use) Administration - First dose	$40.000^[2]	Code not active during this time	xx/xx/xxxx – TBD
0052A	ADM SARSCV2 30MCG TRS-SUCR 2	Pfizer	Pfizer-BioNTech Covid-19 Vaccine (Ready to Use) Administration - Second dose	$40.000^[2]	Code not active during this time	xx/xx/xxxx – TBD
0053A	ADM SARSCV2 30MCG TRS-SUCR 3	Pfizer	Pfizer-BioNTech Covid-19 Vaccine (Ready to Use) Administration - Third dose	$40.000^[2]	Code not active during this time	xx/xx/xxxx – TBD
0054A	ADM SARSCV2 30MCG TRS-SUCR B	Pfizer	Pfizer-BioNTech Covid-19 Vaccine (Ready to Use) Administration - Booster	$40.000^[2]	Code not active during this time	xx/xx/xxxx – TBD
91306	SARSCOV2 VAC 50MCG/0.25ML IM	Moderna	Moderna Covid-19 Vaccine (Low Dose)	$0.010^[1]	Code not active during this time	xx/xx/xxxx – TBD
0064A	ADM SARSCOV2 50MCG/0.25MLBST	Moderna	Moderna Covid-19 Vaccine (Low Dose) Administration - Booster	$40.000^[2]	Code not active during this time	xx/xx/xxxx – TBD
91307	SARSCOV2 VAC 10 MCG TRS-SUCR	Pfizer	Pfizer-BioNTech Covid-19 Pediatric Vaccine	$0.010^[1]	Code not active during this time	xx/xx/xxxx - TBD
0071A	ADM SARSCV2 10MCG TRS-SUCR 1	Pfizer	Pfizer-BioNTech Covid-19 Pediatric Vaccine - Administration - First dose	$40.000^[2]	Code not active during this time	xx/xx/xxxx - TBD
0072A	ADM SARSCV2 10MCG TRS-SUCR 2	Pfizer	Pfizer-BioNTech Covid-19 Pediatric Vaccine - Administration - Second dose	$40.000^[2]	Code not active during this time	xx/xx/xxxx - TBD
M0201	Covid-19 vaccine home admin	Home vaccine admin	Covid-19 vaccine administration inside a patient's home; reported only once per individual home per date of service when only covid-19 vaccine administration is performed at the patient's home	$35.50^[2]	Code not active during this time	06/08/2021 - 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	HCPCS 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]
Q0240^[6]	Casirivi and imdevi 600mg	Regeneron	Injection, casirivimab and imdevimab, 600 mg	$0.010^[1]	Code not active during this time period	07/30/2021 – TBD
M0240^[6]	Casiri and imdev repeat	Regeneron	Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring, subsequent repeat doses	$450.00^[3]	Code not active during this time period	07/30/2021 – TBD
M0241^[6]	Casiri and imdev repeat hm	Regeneron	Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, 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, subsequent repeat doses	$750.00^[3]	Code not active during this time period	07/30/2021 – TBD
Q0243	Casirivimab and imdevimab	Regeneron	Injection, casirivimab and imdevimab, 2400 mg	$0.010^[1]	$0.010^[1]	11/21/2020 – TBD
Q0244^[5]	Casirivi and imdevi 1200 mg	Regeneron	Injection, casirivimab and imdevimab, 1200 mg	$0.010^[1]	$0.010^[1]	06/03/2021 – TBD
M0243	Casirivi and imdevi inj	Regeneron	Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring	$450.00^[3]	$309.600^[3]	11/21/2020 – TBD
M0244	Casirivi and imdevi inj hm	Regeneron	Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, 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
Q0247	Sotrovimab	GSK	Injection, sotrovimab, 500 mg	$2394.00	Code not active during this time period	05/26/2021 – TBD
M0247	Sotrovimab infusion	GSK	Intravenous infusion, sotrovimab, includes infusion and post administration monitoring	$450.00^[3]	Code not active during this time period	05/26/2021 – TBD
M0248	Sotrovimab inf, home admin	GSK	Intravenous infusion, sotrovimab, 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	05/26/2021 – TBD
Q0249	Tocilizumab for COVID-19	Genentech	Injection, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older) with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) only, 1 mg	$6.572	Code not active during this time period	06/24/2021 - TBA
M0249	Adm Tocilizu COVID-19 1st	Genentech	Intravenous infusion, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older) with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) only, includes infusion and post administration monitoring, first dose	$450.00^[3]	Code not active during this time period	06/24/2021 - TBA
M0250	Adm Tocilizu COVID-19 2nd	Genentech	Intravenous infusion, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older) with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) only, includes infusion and post administration monitoring, second dose	$450.00^[3]	Code not active during this time period	06/24/2021 - TBA

^[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.

^[5]On June 3, 2021, the FDA issued an updated EUA for casirivimab and imdevimab that changed the allowed dosing regime from 2400 mg to 1200 mg, and allowed for the administration of the combination product via subcutaneous injection in limited circumstances. Due to these changes, CMS has issued a new product code for casirivimab and imdevimab (Q0244), and updated the descriptors for the existing administration codes (M0243/M0244).

^[6]On July 30, 2021, the FDA revised the EUA for casirivimab and imdevimab to allow its use for post-exposure prophylaxis (PEP) in certain adult and pediatric patients. For patients who meet the criteria for repeat dosing, the authorized dosage is an initial dose of 1200 mg, followed by subsequent repeat dosing of 600 mg once every 4 weeks for the duration of ongoing exposure. Due to this update, CMS has issued a new product code for casirivimab and imdevimab of 600 mg (Q0240), and 2 new codes for the administration of repeat doses of casirivimab and imdevimab (M0240/M0241). Providers and suppliers administering casirivimab and imdevimab for PEP should use M0243 or M0244 for administering the first dose, and M0240 or M0241 for administering subsequent repeat doses.

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

Sotrovimab Emergency Use Authorization

Tocilizumab Emergency Use Authorization

Pfizer-BioNTech COVID-19 Vaccine Emergency Use Authorization (PDF)

Moderna COVID-19 Vaccine Emergency Use Authorization (PDF)