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:
Code |
CPT Short Descriptor |
Labeler Name |
Vaccine/Procedure Name |
Payment Allowance |
Effective Dates |
91300 |
SARSCOV2 VAC 30MCG/0.3ML IM |
Pfizer |
Pfizer-Biontech Covid-19 Vaccine |
$0.010* |
12/11/2020 – TBD |
0001A |
ADM SARSCOV2 30MCG/0.3ML 1ST |
Pfizer |
Pfizer-Biontech Covid-19 Vaccine Administration – First Dose |
$16.940** |
12/11/2020 – TBD |
0002A |
ADM SARSCOV2 30MCG/0.3ML 2ND |
Pfizer |
Pfizer-Biontech Covid-19 Vaccine Administration – Second Dose |
$28.390** |
12/11/2020 – TBD |
91301 |
SARSCOV2 VAC 100MCG/0.5ML IM |
Moderna |
Moderna Covid-19 Vaccine |
$0.010* |
12/18/2020 – TBD |
0011A |
ADM SARSCOV2 100MCG/0.5ML1ST |
Moderna |
Moderna Covid-19 Vaccine Administration – First Dose |
$16.940** |
12/18/2020 – TBD |
0012A |
ADM SARSCOV2 100MCG/0.5ML2ND |
Moderna |
Moderna Covid-19 Vaccine Administration – Second Dose |
$28.390** |
12/18/2020 – TBD |
91302 |
SARSCOV2 VAC 5X10^10VP/.5MLIM |
AstraZeneca |
AstraZeneca Covid-19 Vaccine |
$0.010* |
xx/xx/xxxx – TBD |
0021A |
ADM SARSCOV2 5X10^10VP/.5ML 1 |
AstraZeneca |
AstraZeneca Covid-19 Vaccine Administration – First Dose |
$16.940** |
xx/xx/xxxx – TBD |
0022A |
ADM SARSCOV2 5X10^10VP/.5ML 2 |
AstraZeneca |
AstraZeneca Covid-19 Vaccine Administration – Second Dose |
$28.390** |
xx/xx/xxxx – TBD |
* 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.
Payment Allowances and Effective Dates for COVID-19 Monoclonal Antibodies and their Administration during the Public Health Emergency:
Code |
CPT Short Descriptor |
Labeler Name |
Vaccine/Procedure Name |
Payment Allowance |
Effective Dates |
Q0239 |
bamlanivimab-xxxx |
Eli Lilly |
Injection, bamlanivimab, 700 mg |
$0.010* |
11/10/2020 – TBD |
M0239
|
bamlanivimab-xxxx infusion |
Eli Lilly |
Intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoring |
$309.600*** |
11/10/2020 – TBD |
Q0243 |
casirivimab and imdevimab |
Regeneron |
Injection, casirivimab and imdevimab, 2400 mg |
$0.010* |
11/21/2020 – TBD |
M0243 |
casirivi and imdevi infusion |
Regeneron |
intravenous infusion, casirivimab and imdevimab includes infusion and post administration monitoring |
$309.600*** |
11/21/2020 – TBD |
* 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.
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 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)
Pfizer-BioNTech COVID-19 Vaccine Emergency Use Authorization
Moderna COVID-19 Vaccine Emergency Use Authorization (PDF)
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 Moderna COVID-19 Vaccine
Information about Public Health Emergency
COVID-19 Vaccination Training Programs and Reference Materials for Healthcare Professionals
2021 Geographically-adjusted Payment Rates for Monoclonal Antibody Administration (for Providers & Suppliers Paid MPFS-Adjusted Rates) (ZIP) *Updated 1/7/2021 for Consolidated Appropriations Act, 2021*
2021 Geographically-adjusted Payment Rates for Covid-19 Vaccine Administration (for Providers & Suppliers Paid MPFS-Adjusted Rates) (ZIP) *Updated 1/7/2021 for Consolidated Appropriations Act, 2021*