Is CMS increasing the amount it will pay providers for COVID-19 vaccine administration services?
Yes. On March 15, 2021, CMS announced that it will now reimburse providers $40.00 for each COVID-19 vaccine dose administered. Per CMS:
- “Effective for COVID-19 vaccines administered on or after March 15, 2021, the national average payment rate for physicians, hospitals, pharmacies, and many other immunizers will be $40 to administer each dose of a COVID-19 vaccine. This represents an increase from approximately $28 to $40 for the administration of single-dose vaccines and an increase from approximately $45 to $80 for the administration of COVID-19 vaccines requiring two doses. The exact payment rate for administration of each dose of a COVID-19 vaccine will depend on the type of entity that furnishes the service and will be geographically adjusted based on where the service is furnished.”
It is important to note that the announcement does not state when the Medicare claims processing system will be updated to reflect the higher reimbursement rate. We expect there will likely be some delay in MACs implementing this payment change; especially given that CMS has not yet released its April 2021 Addendum B file, and the January 2021 Addendum B file continues to show the original, lower reimbursement rates for COVID-19 vaccine administration services. We will be sure to provide any updates if and when they become available.
Resources:
CMS MLN Connects Special Edition, “Biden-Harris Administration Increases Medicare Payment for Life-Saving COVID-19 Vaccine”
https://www.cms.gov/outreach-and-educationoutreachffsprovpartprogprovider-partnership-email-archive/2021-03-15-mlnc-se