COVID-19 Vaccines and Monoclonal Antibodies | CMS

Medicare Part B Payment for COVID-19 Vaccines and Certain Monoclonal Antibodies during the Public Health Emergency

CMS has released a set of toolkits for providers, states and insurers to help the health care system prepare and assist in swiftly administering these products once they become available.  These resources are designed to increase the number of providers that can administer the products and ensure adequate reimbursement for administration in Medicare, while making it clear to private insurers and Medicaid programs their responsibility to cover these products at no charge to beneficiaries.  This webpage provides the payment allowances and other related information for these products.  For more information, review the COVID-19 provider toolkit.

Payment Allowances and Effective Dates for COVID-19 Vaccines and their Administration during the Public Health Emergency:

Code

CPT Short Descriptor

Labeler Name

Vaccine/Procedure Name

Payment Allowance

Effective Dates

91300

SARSCOV2 VAC 30MCG/0.3ML IM

Pfizer

Pfizer-Biontech Covid-19 Vaccine

$0.010*

12/11/2020 – TBD

0001A

ADM SARSCOV2 30MCG/0.3ML 1ST

Pfizer

Pfizer-Biontech Covid-19 Vaccine Administration – First Dose

$16.940**

12/11/2020 – TBD

0002A

ADM SARSCOV2 30MCG/0.3ML 2ND

Pfizer

Pfizer-Biontech Covid-19 Vaccine Administration – Second Dose

$28.390**

12/11/2020 – TBD

91301

SARSCOV2 VAC 100MCG/0.5ML IM

Moderna

Moderna Covid-19 Vaccine

$0.010*

12/18/2020 – TBD

0011A

ADM SARSCOV2 100MCG/0.5ML1ST

Moderna

Moderna Covid-19 Vaccine Administration – First Dose

$16.940**

12/18/2020 – TBD

0012A

ADM SARSCOV2 100MCG/0.5ML2ND

Moderna

Moderna Covid-19 Vaccine Administration – Second Dose

 $28.390**

12/18/2020 – TBD

91302

SARSCOV2 VAC 5X10^10VP/.5MLIM

AstraZeneca

AstraZeneca Covid-19 Vaccine

$0.010*

xx/xx/xxxx – TBD

0021A

ADM SARSCOV2 5X10^10VP/.5ML 1

AstraZeneca

AstraZeneca Covid-19 Vaccine Administration – First Dose

$16.940**

xx/xx/xxxx – TBD

0022A

ADM SARSCOV2 5X10^10VP/.5ML 2

AstraZeneca

AstraZeneca Covid-19 Vaccine Administration – Second Dose

 $28.390**

xx/xx/xxxx – TBD

91303 SARSCOV2 VAC AD26 .5ML IM Janssen Janssen Covid-19 Vaccine $0.010* xx/xx/xxxx – TBD
0031A ADM SARSCOV2 VAC AD26 .5ML Janssen Janssen Covid-19 Vaccine Administration $28.390** xx/xx/xxxx – TBD

* Since we anticipate that providers, initially, will not incur a cost for the product, CMS will update the payment allowance at a later date.  Providers should not bill for the product if they received it for free.

** These rates will also be geographically adjusted for many providers.  For providers and suppliers with payments that are geographically adjusted by the methodology used by the Medicare Physician Fee Schedule (MPFS), files with the geographically adjusted payment rates for COVID-19 vaccine administration are included in the “Additional Resources” section below. Certain settings utilize other payment methodologies, such as payment based on reasonable costs.

Payment Allowances and Effective Dates for COVID-19 Monoclonal Antibodies and their Administration during the Public Health Emergency:

Code

CPT Short Descriptor

Labeler Name

Vaccine/Procedure Name

Payment Allowance

Effective Dates

Q0239

bamlanivimab-xxxx

Eli Lilly

Injection, bamlanivimab, 700 mg

 $0.010*

11/10/2020 – TBD

M0239

bamlanivimab-xxxx infusion

Eli Lilly

Intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoring

$309.600***

11/10/2020 – TBD

Q0243

casirivimab and imdevimab

Regeneron

Injection, casirivimab and imdevimab, 2400 mg

$0.010*

11/21/2020 – TBD

M0243

casirivi and imdevi infusion

Regeneron

intravenous infusion, casirivimab and imdevimab includes infusion and post administration monitoring

$309.600***

11/21/2020 – TBD

* Since we anticipate that providers, initially, will not incur a cost for the product, CMS will update the payment allowance at a later date.  Providers should not bill for the product if they received it for free.

*** Medicare will pay a rate of $309.60 for many providers. These rates will also be geographically adjusted for many providers.  For providers and suppliers with payments that are geographically adjusted by the methodology used by the Medicare Physician Fee Schedule (MPFS), files with the geographically adjusted payment rates for monoclonal antibody administration are included in the “Additional Resources” section below. Certain settings utilize other payment methodologies, such as payment based on reasonable costs.

Additional Resources:

Following links contain helpful information for providers. Product NDCs can be found in the EUA Fact Sheet for Healthcare Providers and can be used to identify the appropriate HCPCS codes for each product and its administration.  NDC - HCPCS crosswalk is available in CMS ASP crosswalk zip folder. Long, medium, and short descriptors of COVID-19 CPT codes are available from AMA website.

Medicare Monoclonal Antibody COVID-19 Infusion Program Instruction

Covid-19 NDC-HCPCS crosswalk

COVID-19 Vaccination Resources at CDC

COVID-19 CPT vaccine and immunization codes - AMA

Quick reference guide to the coding structure for Covid-19 vaccine CPT reporting

Bamlanivimab Emergency Use Authorization

Casirivimab and imdevimab Emergency Use Authorization (ZIP)

Pfizer-BioNTech COVID-19 Vaccine Emergency Use Authorization

Moderna COVID-19 Vaccine Emergency Use Authorization (PDF)

Fact Sheet for Healthcare Providers - Emergency Use Authorization of bamlanivimab

Fact Sheet for Healthcare Providers - Emergency Use Authorization of casirivimab and imdevimab

Fact Sheet for Healthcare Providers - Emergency Use Authorization of Pfizer-BioNTech COVID-19 Vaccine

Fact Sheet for Healthcare Providers - Emergency Use Authorization of Moderna COVID-19 Vaccine

Information about Public Health Emergency

COVID-19 Vaccination Training Programs and Reference Materials for Healthcare Professionals

2020 Geographically-adjusted Payment Rates for Monoclonal Antibody Administration (for Providers & Suppliers Paid MPFS-Adjusted Rates) (ZIP) 

2021 Geographically-adjusted Payment Rates for Monoclonal Antibody Administration (for Providers & Suppliers Paid MPFS-Adjusted Rates) (ZIP) *Updated 1/7/2021 for Consolidated Appropriations Act, 2021*

2020 Geographically-adjusted Payment Rates for Covid-19 Vaccine Administration (for Providers & Suppliers Paid MPFS-Adjusted Rates) (ZIP) 

2021 Geographically-adjusted Payment Rates for Covid-19 Vaccine Administration (for Providers & Suppliers Paid MPFS-Adjusted Rates) (ZIP) *Updated 1/7/2021 for Consolidated Appropriations Act, 2021*

https://www.cms.gov/medicare/medicare-part-b-drug-average-sales-price/covid-19-vaccines-and-monoclonal-antibodies