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(s), by dose if necessary
- Vaccine administration code(s) 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 the monoclonal antibody infusions, especially if you plan to roster bill these codes, download and install the newest release of PC-ACE (PDF). This release includes the coding structure, 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 support the administration of the COVID-19 vaccines and the monoclonal antibody infusions, as they become available. CMS and the AMA developed this code structure to make claims processing for COVID-19 vaccines and monoclonal antibody infusions that get FDA EUA or FDA approval more efficient. Most of these codes aren't currently effective and 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.
Codes for Administering the Vaccine in the Patient’s Home
Use HCPCS Level II code M0201 for the additional payment for administering the COVID-19 vaccine to certain Medicare patients in their homes.
- You should report this code in addition to the appropriate CPT code for the product- and dose-specific COVID-19 vaccine administration
- You can only report the HCPCS Level II code for home vaccine administration 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, you should:
- 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 multiple Medicare patients are vaccinated in the same home or communal space
- Report the appropriate CPT code for the product- and dose-specific COVID-19 vaccine administration for each Medicare patient vaccinated in the home that day