Vaccine Pricing

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

Seqirus

Afluria Quadrivalent 0.25ml (2023/2024)

90688

Sanofi Pasteur

Fluzone Quadrivalent (2023/2024)

$20.878

08/01/2023 – 07/31/2024

Seqirus

Afluria Quadrivalent (2023/2024)

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

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