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New payment rates are effective immediately.
The Medicare payment amount for administering the COVID-19 vaccine is increased, effective March 15, 2021.
The national average for physicians, hospitals, pharmacies, and other immunizers to administer the COVID-19 vaccine is now approximately $12 more for the administration of single-dose vaccines and $35 more for the the administration of two-dose vaccines. Actual rates depend on facility type and geographic location.
| Admin Code | Brand | National Payment through 3/14/2021 |
National Payment on or after 3/15/2021 |
| 0001A | Pfizer | $16.940 | $40.000 |
| 0002A | Pfizer | $28.390 | $40.000 |
| 0011A | Moderna | $16.940 | $40.000 |
| 0012A | Moderna | $28.390 | $40.000 |
| 0031A | Janssen* | $28.390 | $40.000 |
Coding and Billing Example
A Medicare patient presents to his provider for the first dose of the Pfizer vaccine on March 12, 2021. The provider bills 91300 Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3mL dosage, diluent reconstituted, for intramuscular use for the vaccine (no charge) and 0001A Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3mL dosage, diluent reconstituted; first dose for the administration. The Medicare Administrative Contractor for the provider in Houston, Texas, adjusts the payment allowance of 0001A to $17.57. When the patient returns for the second dose of the Pfizer vaccine on April 2, 2021, the provider bills 91300 and 0002A … second dose and is reimbursed for the administration at the locality-adjusted rate of $41.24.
The federal government requires most private health plans and issuers to cover the COVID-19 vaccine and its administration with no cost sharing to members during the public health emergency (PHE). The current expiration date for the PHE is April 20, 2021.
In a March 15 press release, CMS says it expects “commercial carriers to continue to ensure that their rates are reasonable in comparison to prevailing market rates.”
Vaccinators can be reimbursed for COVID-19 vaccine administration to uninsured individuals through the Provider Relief Fund, administered by the Health Resources and Services Administration.
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