New payment rates are effective immediately.
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
on or after 3/15/2021
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.”