Covid vaccinators get a big pay increase from Medicare – effective today

by: Laura Evans, CPC Mar 15, 2021

Effective today, providers will get a payment boost from Medicare for administering COVID-19 vaccines.

Physicians, hospitals, pharmacies and other immunizers now will be paid $40 per dose, regardless of whether it is the first or second shot (in the case of Pfizer/BioNTech or Moderna) or single dose (for Johnson & Johnson). CMS says it also will pay $40 to administer the AstraZeneca vaccine once approved by the FDA.

CMS announced the change today in an email to providers. The new rates mark about a 76% increase in payments for the two-dose vaccines, and a 41% boost when administering the Johnson & Johnson shot.

Prior to this, the Medicare national allowable rate for administration of the first vaccine dose was $16.94, and second-dose rate was $28.40. (Under the revised rates, reimbursement will be subject to geographic adjustment). The fees apply to Covid-specific vaccine administration codes, including 0001A and 0002A (Pfizer), 0011A and 0012A (Moderna) and 0031A (Johnson & Johnson), according to CMS’s fee schedule for the codes.

There is no associated fee for CPT vaccine codes 91300-91303 because providers are not currently incurring a cost for them, CMS states.

CMS says it increased providers’ administration fees to “support important actions taken by providers that are designed to increase the number of vaccines they can furnish each day, including establishing new or growing existing vaccination sites, conducting patient outreach and education and hiring additional staff.”

The increased Medicare rates “reflect new information about the costs involved in administering the vaccine for different types of providers and suppliers, and the additional resources necessary to ensure the vaccine is administered safely and appropriately,” the agency stated.

Blog Tags: CMS, COVID-19

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