Medicare COVID-19 Vaccine Shot Payment
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 during and after the PHE.
|Date COVID-19 Vaccine Administered||Medicare Payment Rates for Administering COVID-19 Vaccines|
|On or after March 15, 2021|
|Before March 15, 2021|
These rates reflect updated information about the costs involved in administering the COVID-19 vaccine for different types of providers and the additional resources you need to safely and appropriately administer the vaccine.
For all COVID-19 vaccine administration payment rates listed above, we also geographically adjust the rates based on where you administer the vaccine. Starting January 1, 2023, we’ll also annually update the COVID-19 vaccine administration payment rates to reflect changes in costs related to administering preventive vaccines.
|These rates don’t apply if Medicare pays you for preventive vaccines and their administration at reasonable cost (for example, Federally Qualified Health Centers, Rural Health Clinics, and Hospital-based Renal Dialysis Facilities).|
Payment Rates After the PHE Ends
We’ll continue to pay these rates for administering COVID-19 vaccines through the end of the calendar year in which the current emergency use authorization (EUA) declaration for COVID-19 drugs and biologicals ends. The EUA declaration is distinct from, and not dependent on, the COVID-19 PHE. Learn more about what happens to EUAs when a PHE ends. During this interim time, we’ll maintain the administration payment amounts when you administer COVID-19 vaccines in health care settings and in the home, as described below.
Payment Rates After the EUA Declaration Ends
Effective January 1 of the year following the year in which the EUA declaration for COVID-19 drugs and biologicals ends, we’ll set the payment rate for administering COVID-19 vaccines to align with the payment rate for administering other Part B preventive vaccines ($30 per dose).
Medicare Payment Rates Through December 31, 2023
Effective June 8, 2021, Medicare provided an additional payment amount for administering the COVID-19 vaccine in the home for certain Medicare patients. The end of the PHE doesn’t affect this additional payment amount, and it will continue through CY 2023.
For CY 2023, Medicare pays approximately $36 in addition to the standard administration amount (approximately $40 per COVID-19 vaccine dose) for a total payment of approximately $76 for a vaccine dose administered in a patient's home. We also geographically adjust the additional amount and administration rate based on where you administer the vaccine. Starting January 1, 2023, we’ll also annually update the additional in-home payment rate for administering the COVID-19 vaccine to reflect changes in costs related to administering preventive vaccines.
Medicare Payment Rates Starting January 1, 2024
We established the additional payment amount to ensure access to COVID-19 vaccines during the PHE. We continue to evaluate the needs of Medicare patients and these policies, and we'll address them in the future, as needed.
When Can I Get the Additional In-Home Payment for Administering the COVID-19 Vaccine?
You can get the additional payment for administering the COVID-19 vaccine in Medicare patients’ homes when either of these situations applies:
- The patient has difficulty leaving the home to get the vaccine, which could mean any of these:
- They have a condition, due to an illness or injury, that restricts their ability to leave home without a supportive device or help from a paid or unpaid caregiver.
- They have a condition that makes them more susceptible to contracting a pandemic disease like COVID-19.
- They're generally unable to leave the home. If they do leave home, it requires a considerable and taxing effort.
- The patient is hard-to-reach because they have a disability or face clinical, socioeconomic, or geographical barriers to getting a COVID-19 vaccine in settings other than their home. These patients face challenges that significantly reduce their ability to get vaccinated outside the home, such as challenges with transportation, communication, or caregiving.
Unlike the requirements under the Medicare home health benefit, you or another allowed practitioner don’t need to certify that the Medicare patient is homebound. But, you must document in the patient’s medical record their clinical status or the barriers they face to getting the vaccine outside the home.
What Locations Qualify for the Additional In-Home Payment?
Many types of locations can qualify as a Medicare patient’s home for the additional in-home payment amount, such as:
- A private residence
- Temporary lodging (for example, a hotel or motel, campground, hostel, or homeless shelter)
- An apartment in an apartment complex or a unit in an assisted living facility, group home, or non-Medicaid nursing facility
- A Medicare patient’s home that’s made provider-based to a hospital during the COVID-19 PHE
- Effective August 24, 2021, communal spaces of a multi-unit or communal living arrangement
- Effective August 24, 2021, assisted living facilities participating in the CDC’s Pharmacy Partnership for Long-Term Care Program when their residents are vaccinated through this program
These locations don’t qualify as a home for the additional payment amount:
- Prior to August 24, 2021, communal spaces of a multi-unit living or communal arrangement
- Hospitals (except when the Medicare patient’s home was made provider-based to a hospital during the COVID-19 PHE)
- Medicare skilled nursing facilities (SNFs) and Medicaid nursing facilities, regardless of whether they’re the patient’s permanent residence
What Other Restrictions Apply?
Medicare only pays the additional amount for administering the COVID-19 vaccine in the home if the sole purpose of the visit is to administer a COVID-19 vaccine. Medicare doesn’t pay the additional amount if you provide another Medicare service in the same home on the same date. In those situations, Medicare pays for administering the COVID-19 vaccine at the standard amount (approximately $40 per dose).
If you administer the COVID-19 vaccine to more than 1 Medicare patient in a single home in the same multi-unit or communal living arrangement on the same day:
- Medicare pays approximately $40 to administer each dose of the COVID-19 vaccine, including additional doses and booster doses
- For dates of service between June 8, 2021 and August 24, 2021, Medicare pays the additional payment amount of approximately $35 only once per date of service in that home regardless of how many Medicare patients get the vaccine
- Starting August 24, 2021, through December 31, 2023, Medicare pays the additional payment amount (approximately $36 per dose administered for CY 2023), for up to a maximum of 5 vaccine administration services per home unit or communal space within a single group living location
- You can bill for up to 5 vaccine administration services only when fewer than 10 Medicare patients get a COVID-19 vaccine dose on the same day at the same group living location
- When 10 or more Medicare patients get a COVID-19 vaccine dose at a group living location on the same day, you can only bill for the additional payment once per home (whether the home is an individual living unit or a communal space)
|Date COVID-19 Vaccines Administered (All on the Same Date)||Number of Patients Who Got the Vaccine||Medicare Pays in 2023 (Approximately)||Calculation for 2023 (Approximately)|
|Between June 8, 2021, and August 24, 2021||2 patients in the same home||$115||$35 in-home additional payment + (2 x $40 for each COVID-19 vaccine dose) = $115|
|August 24, 2021, through December 31, 2023||2 patients in the same home||$152||(2 x $36 in-home additional payment) + (2 x $40 for each COVID -19 vaccine dose) = $152|
|August 24, 2021, through December 31, 2023||9 patients in the same home1||$540||(5 x $36 in-home additional payment) + (9 x $40 for each COVID -19 vaccine dose) = $540|
|August 24, 2021, through December 31, 2023||12 patients in the same home2||$516||(1 x $36 in-home additional payment)3 + (12 x $40 for each COVID -19 vaccine dose) = $516|
|August 24, 2021, through December 31, 2023||12 patients in 12 different homes4||$912||(12 x $36 in-home additional payment) + (12 x $40) = $912|
|August 24, 2021, through December 31, 2023||5 patients in a communal space in a group living setting and 3 patients in their individual rooms||$608||(5 x each COVID -19 vaccine dose $36 in-home additional payment for the single communal space) + (3 x $36 in-home additional payment for each of the individual homes) + (8 x $40 for each COVID -19 vaccine dose) = $608|
1Includes a communal space in a group living situation
2Could be an individual living unit or a communal space in a group living situation
3You can only bill for 1 home add-on payment in this situation because you vaccinated 10 or more Medicare patients at the same group living location on the same date
4In other words, each vaccine administered in a distinct individual living unit or communal space of a group living situation