CMS released a set of toolkits for providers, states and insurers to help the health care system prepare to swiftly administer the vaccine. These resources are designed to increase the number of providers that can administer the vaccine and ensure adequate reimbursement for administering the vaccine in Medicare, while making it clear to private insurers and Medicaid programs their responsibility to cover the vaccine at no charge to beneficiaries. In addition, CMS is taking action to increase reimbursement for any new COVID treatments that are approved by the FDA.
Issued by: Centers for Medicare & Medicaid Services (CMS)
The COVID-19 public health emergency (PHE) ended at the end of the day on May 11, 2023. View Infectious diseases for a list of waivers and flexibilities that were in place during the PHE.
This toolkit is for health care providers. Review this page for information about the Medicare COVID-19 Vaccines Toolkit during and after the PHE.
This COVID-19 Vaccine Toolkit is for health care providers and includes information to describe:
- The COVID-19 vaccine Medicare coding structure
- Medicare payment rates for administering COVID-19 vaccines, including a timeline of FDA approvals and EUA amendments for COVID-19 vaccines
- How to bill correctly for administering vaccines, including roster and centralized billing
- Monoclonal antibody infusion for treating COVID-19
If you have questions about billing or reimbursement of vaccine administration for patients covered by private insurance or Medicaid, contact the respective health plan or state Medicaid agency.
Patients who are moderately or severely immunocompromised (have a weakened immune system) are at increased risk of severe COVID-19 illness and death. And, the immune response following COVID-19 vaccination may differ for these patients. Learn about COVID-19 vaccine guidance for moderately or severely immunocompromised patients.
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DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.