Vaccine Pricing

Seasonal Flu Vaccines

Part B payment allowance limits for seasonal influenza (flu) vaccines (that is, the vaccine product) are 95% of the Average Wholesale Price (AWP). In hospital outpatient departments, payment is based on reasonable cost.

Part B deductible and coinsurance amounts don’t apply for flu vaccine products or their administration. With respect to the vaccine product, all providers and suppliers must accept assignment on the claim.

The annual flu vaccine season is August 1–July 31 of the following year.

Get more information on frequency & coverage, billing, and coding.

Flu Season Payment Allowances & Effective Dates

Payment Allowances and Effective Dates for the 2023-2024 Flu Season:

Code	Labeler Name	Vaccine Name	Payment Allowance	Effective Dates
90662	Sanofi Pasteur	Fluzone High-Dose Quadrivalent (2023/2024)	$73.403	08/01/2023 – 07/31/2024
90672	MedImmune	FluMist Quadrivalent (2023/2024)	$27.788	08/01/2023 – 07/31/2024
90674	Seqirus	Flucelvax Quadrivalent (2023/2024) (Preservative Free)	$34.172	08/01/2023 – 07/31/2024
90682	Sanofi Pasteur	Flublok Quadrivalent (2023/2024) (Preservative Free)	$73.403	08/01/2023 – 07/31/2024
90686	GlaxoSmithKline	Fluarix Quadrivalent (2023/2024) (Preservative free) Flulaval Quadrivalent (2023/2024) (Preservative Free)	$22.350	08/01/2023 – 07/31/2024
	Sanofi Pasteur	Fluzone Quadrivalent (2023/2024) (Preservative Free)
	Seqirus	Afluria Quadrivalent (2023/2024) (Preservative Free)
90687	Sanofi Pasteur	Fluzone Quadrivalent 0.25ml (2023/2024)	$10.439	08/01/2023 – 07/31/2024
90687	Seqirus	Afluria Quadrivalent 0.25ml (2023/2024)	$10.439	08/01/2023 – 07/31/2024
90688	Sanofi Pasteur	Fluzone Quadrivalent (2023/2024)	$20.878	08/01/2023 – 07/31/2024
90688	Seqirus	Afluria Quadrivalent (2023/2024)	$20.878	08/01/2023 – 07/31/2024
90694	Seqirus	Fluad Quadrivalent (2023/2024) (Preservative Free)	$77.359	08/01/2023 – 07/31/2024
90756	Seqirus	Flucelvax Quadrivalent (2023/2024)	$32.374	08/01/2023 – 07/31/2024

Payment limits and effective dates for newly approved and marketed influenza vaccines will be posted to this webpage.

Payment Allowances and Effective Dates for the 2022-2023 Flu Season:

Code	Labeler Name	Vaccine Name	Payment Allowance	Effective Dates
90662	Sanofi Pasteur	Fluzone High-Dose Quadrivalent (2022/2023)	$ 69.941	08/01/2022 – 07/31/2023
90672	MedImmune	FluMist Quadrivalent (2022/2023)	$ 26.876	08/01/2022 – 07/31/2023
90674	Seqirus	Flucelvax Quadrivalent (2022/2023) (Preservative Free)	$ 32.278	08/01/2022 – 07/31/2023
90682	Sanofi Pasteur	Flublok Quadrivalent (2022/2023) (Preservative Free)	$ 69.941	08/01/2022 – 07/31/2023
90686	GlaxoSmithKline Sanofi Pasteur Seqirus	Fluarix Quadrivalent (2022/2023) (Preservative Free) Flulaval Quadrivalent (2022/2023) (Preservative Free) Fluzone Quadrivalent (2022/2023) (Preservative Free) Afluria Quadrivalent (2022/2023) (Preservative Free)	$ 21.518	08/01/2022 – 07/31/2023
90687	Sanofi Pasteur Seqirus	Fluzone Quadrivalent 0.25ml (2022/2023) Afluria Quadrivalent 0.25ml (2022/2023)	$ 10.241	08/01/2022 – 07/31/2023
90688	Sanofi Pasteur Seqirus	Fluzone Quadrivalent (2022/2023) Afluria Quadrivalent (2022/2023)	$ 20.482	08/01/2022 – 07/31/2023
90694	Seqirus	Fluad Quadrivalent (2022/2023) (Preservative Free)	$ 71.682	08/01/2022 – 07/31/2023
90756	Seqirus	Flucelvax Quadrivalent (2022/2023)	$ 30.581	08/01/2022 – 07/31/2023

Payment limits and effective dates for newly approved and marketed influenza vaccines will be posted to this webpage.

Locality-Adjusted Payment Rates

Archive Documents

COVID-19 Vaccines & Monoclonal Antibodies

The COVID-19 public health emergency (PHE) ended at the end of the day on May 11, 2023. View Infectious diseases for a list of waivers and flexibilities that were in place during the PHE.

Review this page for information about Medicare payment for administering COVID-19 vaccines and monoclonal antibodies during and after the PHE.

Medicare Part B Payment for COVID-19 Vaccines & Certain Monoclonal Antibodies

This webpage provides the payment allowances and other related information for COVID-19 vaccines and certain monoclonal antibody products. Review the COVID-19 provider toolkit for more information about Medicare and COVID-19 during and after the PHE.

Payment Allowances & Effective Dates for COVID-19 Vaccines & Their Administration: (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 for Medicare Payment
90480	ADMN SARSCOV2 VACC 1 DOSE	N/A	N/A	$40.000^[2]	Code not active during this time	09/11/2023 - 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
91304	SARSCOV2 VAC 5MCG/0.5ML IM	Novavax	Novavax Covid-19 Vaccine, Adjuvanted (Aged 12 years and older)	$148.200^[7]	Code not active during this time	07/13/2022 – TBD
91318	SARSCOV2 VAC 3MCG TRS-SUC	Pfizer-BioNTech	Pfizer-BioNTech COVID-19 Vaccine 2023-2024 Formula (Yellow Cap)	$65.360	Code not active during this time	09/11/2023 - TBD
91319	SARSCV2 VAC 10MCG TRS-SUC IM	Pfizer-BioNTech	Pfizer-BioNTech COVID-19 Vaccine 2023-2024 Formula (Blue Cap)	$87.780	Code not active during this time	09/11/2023 - TBD
91320	SARSCV2 VAC 30MCG TRS-SUC IM	Pfizer-BioNTech	COMIRNATY (COVID-19 Vaccine, mRNA) 2023-2024 Formula	$131.100	Code not active during this time	09/11/2023 - TBD
91321	SARSCOV2 VAC 25 MCG/.25ML IM	Moderna	Moderna COVID-19 Vaccine 2023-2024 Formula	$145.920	Code not active during this time	09/11/2023 - TBD
91322	SARSCOV2 VAC 50 MCG/0.5ML IM	Moderna	SPIKEVAX 2023-2024 Formula	$145.920	Code not active during this time	09/11/2023 - TBD
91300	SARSCOV2 VAC 30MCG/0.3ML IM	Pfizer	Pfizer-BioNTech Covid-19 Vaccine (Aged 12 years and older) (Purple Cap)	$0.010^[1]	$0.010^[1]	12/11/2020 – 04/18/2023
0001A	ADM SARSCOV2 30MCG/0.3ML 1ST	Pfizer	Pfizer-BioNTech Covid-19 Vaccine (Purple Cap) Administration – First Dose	$40.000^[2]	$16.940^[2]	12/11/2020 – 04/18/2023
0002A	ADM SARSCOV2 30MCG/0.3ML 2ND	Pfizer	Pfizer-BioNTech Covid-19 Vaccine (Purple Cap) Administration – Second Dose	$40.000^[2]	$28.390^[2]	12/11/2020 – 04/18/2023
0003A	ADM SARSCOV2 30MCG/0.3ML 3RD	Pfizer	Pfizer-BioNTech Covid-19 Vaccine (Purple Cap) Administration – Third Dose	$40.000^[2]	Code not active during this time	08/12/2021 – 04/18/2023
0004A^[4]	ADM SARSCOV2 30MCG/0.3ML BST	Pfizer	Pfizer-BioNTech Covid-19 Vaccine (Purple Cap) Administration – Booster	$40.000^[2]	Code not active during this time	09/22/2021 – 04/18/2023
91301	SARSCOV2 VAC 100MCG/0.5ML IM	Moderna	Moderna Covid-19 Vaccine (Aged 12 years and older) (Red Cap)	$0.010^[1]	$0.010^[1]	12/18/2020 – 04/18/2023
0011A	ADM SARSCOV2 100MCG/0.5ML1ST	Moderna	Moderna Covid-19 Vaccine (Red Cap) Administration – First Dose	$40.000^[2]	$16.940^[2]	12/18/2020 – 04/18/2023
0012A	ADM SARSCOV2 100MCG/0.5ML2ND	Moderna	Moderna Covid-19 Vaccine (Red Cap) Administration – Second Dose	$40.000^[2]	$28.390^[2]	12/18/2020 – 04/18/2023
0013A	ADM SARSCOV2 100MCG/0.5ML3RD	Moderna	Moderna Covid-19 Vaccine (Red Cap) Administration – Third Dose	$40.000^[2]	Code not active during this time	08/12/2021 – 04/18/2023
91303	SARSCOV2 VAC AD26 .5ML IM	Janssen	Janssen Covid-19 Vaccine (Aged 18 years and older)^[3]	$0.010^[1]	$0.010^[1]	02/27/2021 – 06/01/2023
0031A	ADM SARSCOV2 VAC AD26 .5ML	Janssen	Janssen Covid-19 Vaccine Administration - First Dose^[3]	$40.000^[2]	$28.390^[2]	02/27/2021 – 06/01/2023
0034A	ADM SARSCOV2 VAC AD26 .5ML B	Janssen	Janssen Covid-19 Vaccine Administration - Booster^[3]	$40.000^[2]	Code not active during this time	10/20/2021 – 06/01/2023
0041A	ADM SARSCOV2 5MCG/0.5ML 1ST	Novavax	Novavax Covid-19 Vaccine, Adjuvanted Administration – First Dose	$40.000^[2]	Code not active during this time	07/13/2022 – 10/03/2023
0042A	ADM SARSCOV2 5MCG/0.5ML 2ND	Novavax	Novavax Covid-19 Vaccine, Adjuvanted Administration – Second Dose	$40.000^[2]	Code not active during this time	07/13/2022 – 10/03/2023
0044A	ADM SARSCOV2 5MCG/0.5ML BST	Novavax	Novavax Covid-19 Vaccine, Adjuvanted Administration - Booster	$40.000^[2]	Code not active during this time	10/19/2022 – 10/03/2023
91305	SARSCOV2 VAC 30 MCG TRS-SUCR	Pfizer	Pfizer-BioNTech Covid-19 Vaccine Pre-Diluted (Aged 12 years and older) (Gray Cap)	$0.010^[1]	Code not active during this time	01/03/2022 – 04/18/2023
0051A	ADM SARSCV2 30MCG TRS-SUCR 1	Pfizer	Pfizer-BioNTech Covid-19 Vaccine Pre-Diluted (Gray Cap) Administration - First dose	$40.000^[2]	Code not active during this time	01/03/2022 – 04/18/2023
0052A	ADM SARSCV2 30MCG TRS-SUCR 2	Pfizer	Pfizer-BioNTech Covid-19 Vaccine Pre-Diluted (Gray Cap) Administration - Second dose	$40.000^[2]	Code not active during this time	01/03/2022 – 04/18/2023
0053A	ADM SARSCV2 30MCG TRS-SUCR 3	Pfizer	Pfizer-BioNTech Covid-19 Vaccine Pre-Diluted (Gray Cap) Administration - Third dose	$40.000^[2]	Code not active during this time	01/03/2022 – 04/18/2023
0054A^[4]	ADM SARSCV2 30MCG TRS-SUCR B	Pfizer	Pfizer-BioNTech Covid-19 Vaccine Pre-Diluted (Gray Cap) Administration - Booster	$40.000^[2]	Code not active during this time	01/03/2022 – 04/18/2023
91306	SARSCOV2 VAC 50MCG/0.25ML IM	Moderna	Moderna Covid-19 Vaccine (Aged 18 years and older) (Red Cap) (Low Dose)	$0.010^[1]	Code not active during this time	10/20/2021 – 04/18/2023
0064A^[4]	ADM SARSCOV2 50MCG/0.25MLBST	Moderna	Moderna Covid-19 Vaccine (Red Cap) (Low Dose) Administration - Booster	$40.000^[2]	Code not active during this time	10/20/2021 – 04/18/2023
91307	SARSCOV2 VAC 10 MCG TRS-SUCR	Pfizer	Pfizer-BioNTech Covid-19 Pediatric Vaccine (Aged 5 years through 11 years) (Orange Cap)	$0.010^[1]	Code not active during this time	10/29/2021 - 04/18/2023
0071A	ADM SARSCV2 10MCG TRS-SUCR 1	Pfizer	Pfizer-BioNTech Covid-19 Pediatric Vaccine (Orange Cap) Administration - First dose	$40.000^[2]	Code not active during this time	10/29/2021 - 04/18/2023
0072A	ADM SARSCV2 10MCG TRS-SUCR 2	Pfizer	Pfizer-BioNTech Covid-19 Pediatric Vaccine (Orange Cap) Administration - Second dose	$40.000^[2]	Code not active during this time	10/29/2021 - 04/18/2023
0073A	ADM SARSCV2 10MCG TRS-SUCR 3	Pfizer	Pfizer-BioNTech Covid-19 Pediatric Vaccine (Orange Cap) Administration - Third dose	$40.000^[2]	Code not active during this time	01/03/2022 - 04/18/2023
0074A^[4]	ADM SARSCV2 10MCG TRS-SUCR B	Pfizer	Pfizer-BioNTech Covid-19 Pediatric Vaccine (Orange Cap) Administration - Booster	$40.000^[2]	Code not active during this time	05/17/2022 - 04/18/2023
91308	SARSCOV2 VAC 3MCG TRS-SUCR	Pfizer	Pfizer-BioNTech Covid-19 Pediatric Vaccine (Aged 6 months through 4 years) (Maroon Cap)	$0.010^[1]	Code not active during this time	06/17/2022 - 04/18/2023
0081A	ADM SARSCOV2 3MCG TRS-SUCR 1	Pfizer	Pfizer-BioNTech Covid-19 Pediatric Vaccine (Aged 6 months through 4 years) (Maroon Cap) Administration - First dose	$40.000^[2]	Code not active during this time	06/17/2022 - 04/18/2023
0082A	ADM SARSCOV2 3MCG TRS-SUCR 2	Pfizer	Pfizer-BioNTech Covid-19 Pediatric Vaccine (Aged 6 months through 4 years) (Maroon Cap) Administration - Second dose	$40.000^[2]	Code not active during this time	06/17/2022 - 04/18/2023
0083A	ADM SARSCOV2 3MCG TRS-SUCR 3	Pfizer	Pfizer-BioNTech Covid-19 Pediatric Vaccine (Aged 6 months through 4 years) (Maroon Cap) Administration - Third dose	$40.000^[2]	Code not active during this time	06/17/2022 - 04/18/2023
91309	SARSCOV2 VAC 50MCG/0.5ML IM	Moderna	Moderna Covid-19 Vaccine (Aged 6 years through 11 years or aged 18 years and older) (Blue Cap with purple border) 50MCG/0.5ML^[5]	$0.010^[1]	Code not active during this time	03/29/2022 - 04/18/2023
0091A	ADM SARSCOV2 50 MCG/.5 ML1ST	Moderna	Moderna Covid-19 Pediatric Vaccine (Aged 6 years through 11 years) (Blue Cap with purple border) Administration - First dose	$40.000^[2]	Code not active during this time	06/17/2022 - 04/18/2023
0092A	ADM SARSCOV2 50 MCG/.5 ML2ND	Moderna	Moderna Covid-19 Pediatric Vaccine (Aged 6 years through 11 years) (Blue Cap with purple border) Administration - Second dose	$40.000^[2]	Code not active during this time	06/17/2022 - 04/18/2023
0093A	ADM SARSCOV2 50 MCG/.5 ML3RD	Moderna	Moderna Covid-19 Pediatric Vaccine (Aged 6 years through 11 years) (Blue Cap with purple border) Administration - Third dose	$40.000^[2]	Code not active during this time	06/17/2022 - 04/18/2023
0094A^[4]	ADM SARSCOV2 50MCG/0.5 MLBST	Moderna	Moderna Covid-19 Vaccine (Aged 18 years and older) (Blue Cap with purple border) 50MCG/0.5ML Administration - Booster	$40.000^[2]	Code not active during this time	03/29/2022 - 04/18/2023
91311	SARSCOV2 VAC 25MCG/0.25ML IM	Moderna	Moderna Covid-19 Pediatric Vaccine (Aged 6 months through 5 years) (Blue Cap with magenta border) 250MCG/0.25ML	$0.010^[1]	Code not active during this time	06/17/2022 - 04/18/2023
0111A	ADM SARSCOV2 25MCG/0.25ML1ST	Moderna	Moderna Covid-19 Pediatric Vaccine (Aged 6 months through 5 years) (Blue Cap with magenta border) Administration - First dose	$40.000^[2]	Code not active during this time	06/17/2022 - 04/18/2023
0112A	ADM SARSCOV2 25MCG/0.25ML2ND	Moderna	Moderna Covid-19 Pediatric Vaccine (Aged 6 months through 5 years) (Blue Cap with magenta border) Administration - Second dose	$40.000^[2]	Code not active during this time	06/17/2022 - 04/18/2023
0113A	ADM SARSCOV2 25MCG/0.25ML3RD	Moderna	Moderna Covid-19 Pediatric Vaccine (Aged 6 months through 5 years) (Blue Cap with magenta border) Administration - Third dose	$40.000^[2]	Code not active during this time	06/17/2022 - 04/18/2023
91312	SARSCOV2 VAC BVL 30MCG/0.3M	Pfizer	Pfizer-BioNTech COVID-19 Vaccine, Bivalent Product (Aged 12 years and older) (Gray Cap)	$0.010^[1]	Code not active during this time	08/31/2022 – 09/12/2023
0124A	ADM SARSCV2 BVL 30MCG/.3ML B	Pfizer	Pfizer-BioNTech COVID-19 Vaccine, Bivalent (Aged 12 years and older) (Gray Cap) Administration – Additional Dose	$40.000^[2]	Code not active during this time	08/31/2022 – 09/12/2023
91313	SARSCOV2 VAC BVL 50MCG/0.5ML	Moderna	Moderna COVID-19 Vaccine, Bivalent Product (Aged 12 years and older) (Dark Blue Cap with gray border)^[6]	$0.010^[1]	Code not active during this time	08/31/2022 – 09/12/2023^[6]
0134A	ADM SARSCV2 BVL 50MCG/.5ML B	Moderna	Moderna COVID-19 Vaccine, Bivalent (Aged 12 years and older) (Dark Blue Cap with gray border) Administration – Additional Dose^[6]	$40.000^[2]	Code not active during this time	08/31/2022 – 09/12/2023^[6]
91314	SARSCOV2 VAC BVL 25MCG/0.25ML	Moderna	Moderna COVID-19 Vaccine, Bivalent Product (Aged 6 months through 11 years) (Dark Blue Cap with gray border)	$0.010^[1]	Code not active during this time	10/12/2022 – 09/12/2023
0144A	ADM SARSCV2 BVL 25MCG/.25ML B	Moderna	Moderna COVID-19 Vaccine, Bivalent (Aged 6 years through 11 years) (Dark Blue Cap with gray border) Administration – Additional Dose	$40.000^[2]	Code not active during this time	10/12/2022 – 09/12/2023
91315	SARSCOV2 VAC BVL 10MCG/0.2ML	Pfizer	Pfizer-BioNTech COVID-19 Vaccine, Bivalent Product (Aged 5 years through 11 years) (Orange Cap)	$0.010^[1]	Code not active during this time	10/12/2022 – 09/12/2023
0154A	ADM SARSCV2 BVL 10MCG/.2ML B	Pfizer	Pfizer-BioNTech COVID-19 Vaccine, Bivalent Product (Aged 5 years through 11 years) (Orange Cap) Administration – Additional Dose	$40.000^[2]	Code not active during this time	10/12/2022 – 09/12/2023
91316	SARSCOV2 VAC BVL 10MCG/0.2ML	Moderna	Moderna COVID-19 Vaccine, Bivalent Product (Aged 6 months through 5 years) (Dark Pink Cap and a label with a yellow box)	$0.010^[1]	Code not active during this time	12/08/2022 – 09/12/2023
0164A	ADM SRSCV2 BVL 10MCG/0.2ML B	Moderna	Moderna COVID-19 Vaccine, Bivalent (Aged 6 months through 5 years) (Dark Pink Cap and label with a yellow box) Administration – Additional Dose	$40.000^[2]	Code not active during this time	12/08/2022 – 09/12/2023
91317	SARSCOV2 VAC BVL 3MCG/0.2ML	Pfizer	Pfizer-BioNTech COVID-19 Vaccine, Bivalent Product (Aged 6 months through 4 years) (Maroon Cap)	$0.010^[1]	Code not active during this time	12/08/2022 – 09/12/2023
0173A	ADM SARSCV2 BVL 3MCG/0.2ML 3	Pfizer	Pfizer-BioNTech Covid-19 Pediatric Vaccine (Aged 6 months through 4 years) (Maroon Cap) Administration - Additional Dose	$40.000^[2]	Code not active during this time	12/08/2022 – 09/12/2023
0174A	ADM SARSCV2 BVL 3MCG/0.2ML B	Pfizer	Pfizer-BioNTech Covid-19 Pediatric Vaccine (Aged 6 months through 4 years) (Maroon Cap) Administration – Additional Dose	$40.000^[2]	Code not active during this time	03/14/2023 – 09/12/2023
0121A	ADM SARSCV2 BVL 30MCG/.3ML 1	Pfizer	Pfizer-BioNTech COVID-19 Bivalent (12 years and older) Administration – Single Dose	$40.000^[2]	Code not active during this time	04/18/2023 - 09/12/2023
0151A	ADM SARSCV2 BVL 10MCG/.2ML 1	Pfizer	Pfizer-BioNTech COVID-19 Bivalent Pediatric Vaccine (5 years through 11 years) Administration – Single Dose	$40.000^[2]	Code not active during this time	04/18/2023 - 09/12/2023
0171A	ADM SARSCV2 BVL 3MCG/0.2ML 1	Pfizer	Pfizer-BioNTech COVID-19 Bivalent Pediatric Vaccine (6 months through 4 years) Administration – First Dose	$40.000^[2]	Code not active during this time	04/18/2023 - 09/12/2023
0172A	ADM SARSCV2 BVL 3MCG/0.2ML 2	Pfizer	Pfizer-BioNTech COVID-19 Bivalent Pediatric Vaccine (6 months through 4 years) Administration – Second Dose	$40.000^[2]	Code not active during this time	04/18/2023 - 09/12/2023
0141A	ADM SRSCV2 BVL 25MCG/.25ML 1	Moderna	Moderna COVID-19 Vaccine, Bivalent Pediatric Vaccine (6 months through 11 years) Administration – First Dose	$40.000^[2]	Code not active during this time	04/18/2023 - 09/12/2023
0142A	ADM SRSCV2 BVL 25MCG/.25ML 2	Moderna	Moderna COVID-19 Vaccine, Bivalent Pediatric Vaccine (6 months through 11 years) Administration – Second Dose	$40.000^[2]	Code not active during this time	04/18/2023 - 09/12/2023

^[1] Since we anticipate that providers, initially, won’t incur a cost for the product, CMS will update the payment allowance at a later date. Providers shouldn’t bill for the product if they got it for free.

^[2] We’ll also geographically adjust these rates for many providers. We’ve included files with the geographically adjusted payment rates for COVID-19 vaccine administration in the “Additional Resources” section below. Certain settings use other payment methodologies, such as payment based on reasonable costs. Starting January 1, 2023, we’ll also annually update the COVID-19 vaccine payment rates to reflect changes in costs related to administering preventive vaccines.

^[3] Johnson & Johnson COVID-19 vaccine. On May 5, 2022, the FDA limited the authorized use of the Janssen COVID-19 vaccine. On June 1, 2023, FDA revoked the EUA for this vaccine.

^[4] Administration booster codes should be billed for all applicable booster doses as approved and/or authorized by the FDA.

^[5] On June 17, 2022, FDA authorized the 50MCG/0.5ML presentation of the Moderna COVID-19 vaccine to provide primary series doses in individuals 6 - 11 years of age in addition to the March 29, 2022, FDA authorization to provide booster vaccination doses in individuals 18 years and older.

^[6] On October 12, 2022, the FDA authorized the Moderna bivalent product (dark blue cap with gray border) and its administration for use as a single booster dose in individuals 12 - 17 years old in addition to the August 31, 2022, FDA authorization as a single booster dose in individuals 18 years and older.

^[7] Effective October 3, 2023, CMS updated the payment allowance. Providers shouldn’t bill for the product if they got it for free.

Payment Allowances & Effective Dates for COVID-19 Monoclonal Antibodies & Their Administration:

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
Q0220 Note: This product isn’t currently authorized^[12]	Tixagev and cilgav, 300mg	AstraZeneca	Injection, tixagevimab and cilgavimab, for the pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available covid-19 vaccine is not recommended due to a history of severe adverse reaction to a covid-19 vaccine(s) and/or covid-19 vaccine component(s), 300 mg	$0.010^[1]	Code not active during this time period	12/08/2021 - TBD
Q0221 Note: This product isn’t currently authorized^[12]	Tixagev and cilgav, 600mg	AstraZeneca	Injection, tixagevimab and cilgavimab, for the pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available covid-19 vaccine is not recommended due to a history of severe adverse reaction to a covid-19 vaccine(s) and/or covid-19 vaccine component(s), 600 mg	$0.010^[1]	Code not active during this time period	02/24/2022 - TBD
M0220 Note: This product isn’t currently authorized^[12]	Tixagev and cilgav inj	AstraZeneca	Injection, tixagevimab and cilgavimab, for the pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available covid-19 vaccine is not recommended due to a history of severe adverse reaction to a covid-19 vaccine(s) and/or covid-19 vaccine component(s), includes injection and post administration monitoring	$150.50^[3]	Code not active during this time period	12/08/2021 - TBD
M0221 Note: This product isn’t currently authorized^[12]	Tixagev and cilgav inj hm	AstraZeneca	Injection, tixagevimab and cilgavimab, for the pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available covid-19 vaccine is not recommended due to a history of severe adverse reaction to a covid-19 vaccine(s) and/or covid-19 vaccine component(s), includes 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	$250.50^[3]	Code not active during this time period	12/08/2021 - TBD
Q0222 Note: This product isn’t currently authorized^[11]	Bebtelovimab 175 mg	Eli Lilly	Injection, bebtelovimab, 175 mg	$2394.00^{[1] [1a]}	Code not active during this time period	02/11/2022 - TBD
M0222 Note: This product isn’t currently authorized^[11]	Bebtelovimab injection	Eli Lilly	Intravenous injection, bebtelovimab, includes injection and post administration monitoring	$350.50^[3]	Code not active during this time period	02/11/2022 - TBD
M0223 Note: This product isn’t currently authorized^[11]	Bebtelovimab injection home	Eli Lilly	Intravenous injection, bebtelovimab, includes 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	$550.50^[3]	Code not active during this time period	02/11/2022 - TBD
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] Note: This product isn’t currently authorized^[9]	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] Note: This product isn’t currently authorized^[9]	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] Note: This product isn’t currently authorized^[9]	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 Note: This product isn’t currently authorized^[9]	Casirivimab and imdevimab	Regeneron	Injection, casirivimab and imdevimab, 2400 mg	$0.010^[1]	$0.010^[1]	11/21/2020 – TBD
M0243 Note: This product isn’t currently authorized^[9]	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
Q0244^[5] Note: This product isn’t currently authorized^[9]	Casirivi and imdevi 1200 mg	Regeneron	Injection, casirivimab and imdevimab, 1200 mg	$0.010^[1]	$0.010^[1]	06/03/2021 – TBD
M0244 Note: This product isn’t currently authorized^[9]	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^[8] Note: This product isn’t currently authorized^[9]	Bamlanivimab and etesevima	Eli Lilly	Injection, bamlanivimab and etesevimab, 2100 mg	$0.010^[1]	$0.010^[1]	02/09/2021 – TBD
M0245^[8] Note: This product isn’t currently authorized^[9]	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^[8] Note: This product isn’t currently authorized^[9]	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^[7] Note: This product isn’t currently authorized^[10]	Sotrovimab	GSK	Injection, sotrovimab, 500 mg	$2394.00	Code not active during this time period	05/26/2021 – TBD
M0247 Note: This product isn’t currently authorized^[10]	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 Note: This product isn’t currently authorized^[10]	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^[2]	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

^[1] Providers shouldn't bill for the product if they got it for free through the USG-purchased inventory.

^[1a] Payment rate effective for dates of service on or after August 15, 2022. Providers should only bill Medicare for commercially purchased products.

^[2] Given the limited clinical situations allowed under the EUA, providers should only bill for tocilizumab on a 12x type of bill (TOB).

^[3] We’ll geographically adjust these rates for many providers. We’ve included files with the geographically adjusted payment rates for monoclonal antibody administration in the “Additional Resources” section below. Certain settings use 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. As a result, Medicare won't pay for claims with HCPCS codes M0239 or Q0239 with dates of service after April 16, 2021.

^[5]On June 3, 2021, the FDA revised the EUA for casirivimab and imdevimab to change the allowed dosing regimen from 2400 mg to 1200 mg and allow providers to administer the combination product by subcutaneous injection in limited circumstances. As a result, CMS 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. As a result, CMS 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 who administer casirivimab and imdevimab for PEP should use M0243 or M0244 for administering the first dose and M0240 or M0241 for administering subsequent repeat doses.

^[7] When the government provides monoclonal antibody products to treat COVID-19 for free, providers should only bill for the administration. Don’t include the monoclonal antibody product codes on these claims. If you got the product for free and your systems require a product code to bill for the administration, enter $0.01 for the billed amount.

^[8] On September 16, 2021, the FDA revised the EUA for bamlanivimab and etesevimab, administered together, to allow its use for post-exposure prophylaxis (PEP) in certain adult and pediatric patients. Providers should use Q0245 and M0245 or M0246 to bill for administering bamlanivimab and etesevimab for PEP.

^[9] On January 24, 2022, the FDA announced that, due to the high frequency of the Omicron variant, REGEN-COV (casirivimab and imdevimab, administered together) isn’t currently authorized in any U.S region. Therefore, you may not administer REGEN-COV for treatment or post-exposure prevention of COVID-19 under the EUA until further notice.

^[10] On April 5, 2022, the FDA announced that, due to the high frequency of the Omicron BA.2 sub-variant, sotrovimab isn’t currently authorized in any U.S. region. Therefore, you may not administer sotrovimab to treat COVID-19 under the EUA until further notice.

^[11] On November 30, 2022, the FDA announced that bebtelovimab isn’t currently authorized in any U.S. region because it isn’t expected to neutralize Omicron sub-variants BQ.1 and BQ.1.1. Therefore, you may not administer bebtelovimab to treat COVID-19 under the EUA until further notice.

^[12] On January 26, 2023, the FDA announced that EVUSHELD isn’t currently authorized for emergency use in the U.S.

COVID-19 Vaccine Resources

Get HCPCS codes for each product and its administration:
- COVID-19 CPT vaccine and immunization codes - AMA: View for long, medium, and short descriptions of COVID-19 CPT codes
- COVID-19 NDC-HCPCS crosswalk
CDC COVID-19 Vaccination Resources
COVID-19 Vaccination Training Programs and Reference Materials for Healthcare Professionals
Information about Public Health Emergency
COVID-19 Monoclonal Antibodies
Quick reference guide to the coding structure for COVID-19 vaccine CPT reporting
COVID-19 provider toolkit: Get more information about Medicare and COVID-19
Vaccine Authorization Letters & Fact Sheets
Monoclonal Antibody EUAs & Fact Sheets for Healthcare Providers
- ACTEMRA® (tocilizumab): EUA and EUA Fact Sheet
- Bamlanivimab: EUA and EUA Fact Sheet
- Bamlanivimab and etesevimab: EUA and EUA Fact Sheet
- Bebtelovimab: EUA and EUA Fact Sheet
- EvusheldTM (tixagevimab co-packaged with cilgavimab): EUA and EUA Fact Sheet
- REGEN-COV® (casirivimab and imdevimab): EUA and EUA Fact Sheet
- Sotrovimab: EUA and EUA Fact Sheet

Geographically-adjusted Payment Rates

2023

Jan - Dec 2023 Geographically-adjusted Payment Rates for COVID-19 Vaccine Administration [For claims with dates of service 10/03/2023 through 12/31/2023] *Updated 10/05/2023 to remove codes describing the service to administer COVID-19 vaccines that are no longer authorized in the U.S. for the Novavax vaccine, Adjuvanted (effective 10/03/2023)

Jan - Dec 2023 Geographically-adjusted Payment Rates for Monoclonal Antibody Administration [For claims with dates of service 01/01/2023 through 12/31/2023] *Updated 07/14/2023 to reflect locality revisions for Puerto Rico (PR) and the Virgin Islands (VI)

2022

Jan - Dec 2022 Geographically-adjusted Payment Rates for COVID-19 Vaccine Administration (for Providers & Suppliers Paid MPFS-Adjusted Rates) (ZIP) *Updated 12/20/2022 to reflect the new codes for Moderna and Pfizer-BioNTech pediatric bivalent (updated COVID-19 vaccines) booster dose/ third dose [For claims with dates of service 12/08/2022 through 12/31/2022]

Jan - Dec 2022 Geographically-adjusted Payment Rates for Monoclonal Antibody Administration (for Providers & Suppliers Paid MPFS-Adjusted Rates) (ZIP) *Updated 02/17/2022 to reflect the new codes for bebtelovimab [For claims with dates of service 02/11/2022 through 12/31/2022]

2021

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 11/02/2021 to account for effective dates for Pfizer-BioNTech COVID-19 Pediatric Vaccine [For claims with dates of service 3/15/2021 through 12/31/2021]

Jan-May 2021 Geographically-adjusted Payment Rates for Monoclonal Antibody Administration (for Providers & Suppliers Paid MPFS-Adjusted Rates) (ZIP) [For claims with dates of service of 1/1/2021 through 5/5/2021]

May-Dec 2021 Geographically-adjusted Payment Rates for Monoclonal Antibody Administration (for Providers & Suppliers Paid MPFS-Adjusted Rates) (ZIP) *Updated 12/23/2021 to account for new codes for tixagevimab co-packaged with cilgavimab* [For claims with dates of service 5/6/2021 through 12/31/2021]

Page Last Modified:

10/05/2023 03:42 PM

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