Coding for COVID-19 Vaccine Shots

After the FDA issues an emergency use authorization (EUA) or approves licensure of each COVID-19 vaccine product, CMS will identify the following for Medicare payment:

• Vaccine code, by dose if necessary
• Vaccine administration code for each dose

CMS and the American Medical Association (AMA) collaborated on a new approach to report use of COVID-19 vaccines. If you plan to administer the COVID-19 vaccines or COVID-19 monoclonal antibody products, especially if you plan to roster bill for codes that describe these services, download and install the newest release of PC-ACE (PDF). This release includes the coding structure for COVID-19 vaccine and monoclonal antibody products, currently comprised of both of these:

• An AMA-issued HCPCS Level I CPT code structure
• A CMS-issued HCPCS Level II code structure

Together, these codes describe the administration of the COVID-19 vaccines and the monoclonal antibody products, as they become available. CMS and the AMA developed this code structure to make claims processing for administration of COVID-19 vaccines and monoclonal antibody infusions that get FDA EUA or FDA approval more efficient. Many of these codes are placeholders and aren't currently effective until an authorized product is specifically assigned. It's possible that we won't use all codes. We'll issue specific code descriptors in the future. Medicare effective dates for the codes will match with the date of the FDA EUA or FDA approval.

Get the most current list of billing codes, payment allowances and effective dates.

Codes for Administering the Vaccine in the Patient’s Home

Use HCPCS Level II code M0201 to bill for the additional payment for administering the COVID-19 vaccine to Medicare patients in their homes under certain circumstances.

• Report this code in addition to the appropriate CPT code for the product- and dose-specific code that describes the COVID-19 vaccine administration
• You can only report this code once per home per date of service
• If you administer the COVID-19 vaccine to more than 1 Medicare patient in a single home on the same day:
  • For dates of service between June 8, 2021, and August 24, 2021, only report the HCPCS Level II code M0201 once per individual home or living unit 
  • For dates of service on or after August 24, 2021, if you administer the vaccine to fewer than 10 Medicare patients at the same group living location on that date, report the HCPCS Level II code M0201 for each Medicare patient vaccinated in an individual home that day, and up to a maximum of 5 times if you vaccinate multiple Medicare patients in the same home or communal space
  • Report the appropriate product- and dose-specific COVID-19 vaccine administration CPT code for each Medicare patient you vaccinated in the home that day