Claims for reimbursement will be priced as described below for eligible services and subject to available funding.
See coverage details.
Reimbursement Details
Reimbursement pricing and policies under this program for eligible services, as determined by HRSA (subject to adjustment as may be necessary), are described below:
Reimbursement will be based on current year Medicare fee schedule rates except where otherwise noted.
Publication of new codes and updates to existing codes will be made in accordance with published CMS guidance.
For any new codes where a CMS published rate does not exist, claims will be held until CMS publishes corresponding reimbursement information.
FDA-licensed or authorized vaccine administration fees are priced based on national Medicare rates and are outlined below.
- For dates of service through March 14, 2021:
- Administration of a single-dose COVID-19 vaccine - $28.39
- Administration of the first dose of a COVID-19 vaccine requiring a series of two or more doses - $16.94
- Administration of the final dose of a COVID-19 vaccine requiring a series of two or more doses - $28.39
- For dates of service on or after March 15, 2021:
- Administration (per dose) of a COVID-19 vaccine - $40.00
- Effective August 12, 2021, this includes an additional (third) dose of a COVID-19 vaccine for certain immunocompromised individuals (refer to the CDC website for more information).
- Administration (per dose) of a COVID-19 vaccine - $40.00
- For COVID-19 vaccinations administered in-home* with dates of service on or after June 8, 2021:
- Administration (per dose) of a COVID-19 vaccine - $75.50
- Effective August 12, 2021, this includes an additional (third) dose of a COVID-19 vaccine for certain immunocompromised individuals (refer to the CDC website for more information).
- *Note: In-home vaccine administration claims must be submitted with two codes to be eligible for reimbursement:
- The first code must be one of the following:
- Pfizer: 0001A, 0002A, 0003A, D1701, D1702
- Moderna: 0011A, 0012A, 0013A, D1703, D1704
- Janssen: 0031A, D1707
- The second code must be M0201 (COVID-19 vaccine home administration)
- For a definition of what constitutes in-home administration, see this Centers for Medicare & Medicaid Services fact sheet.
- The first code must be one of the following:
- Administration (per dose) of a COVID-19 vaccine - $75.50
Claims submitted electronically for professional services
Claims submitted electronically for professional services will be priced as follows:
Services will price with current year CMS pricing with geographic adjustments, as applicable.
If no geographic adjustments are applicable, services will price with current year CMS national pricing.
COVID-19 testing and specimen collection procedures will price in accordance with rates published in the CARES Act (PDF) and CMS interim final rules
For ground, water and air ambulance claims with a primary diagnosis of COVID-19, professional claims price at current year CMS pricing with geographic adjustments as applicable.
Claims submitted electronically for facility services
Claims submitted electronically for facility services will generally price according to traditional Medicare reimbursement; examples of exceptions are noted below:
For purposes of this program, facility reimbursement based on IPPS will not include the 20% increase to the DRG weight for COVID-19 diagnoses U07.1 and B97.29 authorized by Section 3710 of the CARES Act.
For purposes of this program, reimbursement rates for facilities not paid on IPPS [Critical Access Hospitals (CAHs), Rural Health Clinics (RHCs), Children's Hospitals, and PPS Exempt Cancer Hospitals] will not be updated after February 4, 2020.
For ambulance claims with a primary diagnosis of COVID-19, the following rates apply:
- Ground or water: $350 per claim
- Air: $2,300 per claim
Home health services will be priced based on a per-visit methodology by service type as established by the program:
All Medicare-eligible service categories: PT/OT/ST
$90Nursing services – skilled nursing
$90Nursing services – licensed practical nurse
$60Medical social services
$90Home health aide
$30Home infusion therapy – PICC/midline supplies
$70Home infusion therapy – PICC/midline placement
$110All claims submitted must be complete and final. Corrected claims, late charges, voided claim transactions and appeals will not be accepted. Interim bills may be accepted for outpatient hospital claims with dates of service that cross over a calendar year.
