MEDICARE PAYMENT for COVID-19 Vaccination
Administration in the Home
Disclaimer: The contents of this document do not have the force and eect of law and are not meant to bind the public in any way, unless specically
incorporated into a contract. This document is intended only to provide clarity to the public regarding existing requirements under the law.
Eective June 8, 2021, in addition to the current payment amount, Medicare will pay an additional amount of $35 per dose for
administering the Coronavirus disease 2019 (COVID-19) vaccine in the home for certain Medicare patients that have diiculties
leaving their homes or are hard-to-reach. This payment also applies when additional doses of the COVID-19 vaccine are
administered in the home to certain Medicare patients on or aer August 12, 2021.
Medicare will pay the $35 amount in addition to the standard administration amount (approximately $40 per COVID-19 vaccine dose), for
a total payment of approximately $75 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.
Examples of Patient Situations for which the Additional Payment Amount Applies
1
:
• The patient has a condition that makes them more susceptible to contracting a pandemic disease such as COVID-19.
•
• The patient has a disability or faces clinical, socioeconomic, or geographical barriers to getting a COVID-19 vaccine in settings other
than their home.
•
transportation, communication, or caregiving.
EXAMPLES OF PAYMENT FOR VACCINE ADMINISTRATION IN DIFFERENT LOCATIONS
Location Payment for vaccine
administration
Payment for additional
in-home rate
Expected Patient
Cost-Sharing
A private residence
No Charge to Patient
Temporary lodging (for example, a hotel or motel,
campground, hostel, or homeless shelter)
No Charge to Patient
An apartment in an apartment complex or a unit in an
assisted living facility or group home
No Charge to Patient
A Medicare patient’s home that’s made
provider-based to a hospital during the COVID-19
public health emergency
2
No Charge to Patient
Communal space of a multi-unit or communal living
arrangement
3
No Charge to Patient
Inpatient Hospital, Medicare skilled nursing facility
,
or Medicaid nursing facility No Charge to Patient
No Charge to Patient
Patient Assistedliving facility participating in the
CDC’sPharmacy Partnership for Long-Term Care
Program
5
when their residents are vaccinated through
this program
No Charge to Patient
1
You must document the patient’s clinical status or the barriers they face to getting the vaccine outside the home. More information is available online in the Provider Toolkit.
2
In response to the COVID-19 PHE, CMS issued several 1135 waivers (PDF) to let hospitals provide services, including administering vaccines, in temporary expansion sites. CMS doesn’t pay
for preventive vaccine administration under the Outpatient Prospective Payment System (OPPS) or the Physician Fee Schedule (PFS). So, we pay hospitals to administer COVID-19 vaccines
3
4
CMS will continue to exercise enforcement discretion to allow Medicare-enrolled immunizers working within their scope of practice and applicable state law to bill directly and
receive direct reimbursement from the Medicare program for administering COVID-19 vaccines to Medicare Part A Skilled Nursing Facility residents.
5
CDC’s Pharmacy Partnership for Long-Term Care Program may qualify as a patient’s home for the additional
in-home payment if the facility meets all other criteria for the additional in-home payment.
August 2021
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 approximately $40 per dose for administering the COVID-19
vaccine.
If you administer the COVID-19 vaccine to more than 1 Medicare patient in a single home on the
same day, Medicare pays:
• Approximately $40 to administer each dose of the COVID-19 vaccine, including additional
• 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 receive the vaccine
•
$35 per dose administered), for up to a maximum of 5 vaccine administration services per
home unit or communal space within a single group living location; but only when fewer than 10 Medicare patients receive a
COVID-19 vaccine dose on the same day at the same group living location.
For example, if you administer a COVID-19 vaccine on the same date between June 8, 2021 and August 24, 2021 to 2 Medicare patients in the
same home, Medicare pays approximately $115 ($35 for the in-home vaccine administration rate plus 2 x $40 for each dose of the COVID-19
vaccine). Eective August 24, 2021, if you administer a dose of the COVID-19 vaccine on the same date to 2 Medicare patients in the same
home, Medicare pays approximately $150 (2 x $35 for the in-home vaccine administration, plus 2 x $40 for each dose of the COVID-19 vaccine).
More examples can be found online in the Provider Toolkit.
(2 x $35 )+ (2 x $40) = $150
MEDICARE PAYS
Billing for the Additional Payment for Administering the Vaccine in the
Patient’s Home
Coding
• DO use the appropriate Current Procedural Terminology (CPT) code for the product and dose-
• DO use the Healthcare Common Procedure Coding System (HCPCS) Level II code M0201 for the
additional payment rate for administering the COVID-19 vaccine in the home
Billing
• DO bill for the additional in-home payment amount if the sole purpose of the visit is to administer a COVID-19 vaccine.
• DO
vaccinated in a single home unit or communal space and up to a maximum of 5 times if fewer than 10 Medicare patients are
vaccinated on the same day in the same group living location.
• DON’T bill for the additional amount more than once for dates of service between June 8, 2021, and August 24, 2021 if you
administer the COVID-19 vaccine to more than 1 Medicare patient in a single home on the same day
Roster Billing
• If you submit roster bills for administering the COVID-19 vaccine in the home, you must submit
2 roster bills:
−
administration
− A second roster bill containing the HCPCS Level II code (M0201) for the additional in-home payment
amount
• You may submit a single set of roster bills (one containing M0201 and another containing the appropriate
CPT code) for multiple Medicare patients who get the COVID-19 vaccine in their individual units of a multi-unit living
group living setting, you may submit a roster bill for M0201 for up to a maximum of 5 Medicare patients in the same home,
including for multiple Medicare patients vaccinated in a communal space of the multi-unit living arrangement.
This communication was printed, published, or produced and disseminated at U.S. taxpayer expense.
