How are the reimbursement rates determined?

Reimbursement pricing and policies under this program, as determined by HRSA are described below.

• Vaccine administration fees will be priced based on national Medicare rates for administering the COVID-19 vaccine (not geographically adjusted) 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).
• 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, 0071A, 0072A
      • Moderna: 0011A, 0012A, 0013A, 0064A
      • Janssen: 0031A, 0034A
    • The second code must be M0201 (COVID-19 vaccine home administration)
    • For a definition of what constitutes in-home administration, see this CMS fact sheet (PDF - 138 KB).
• These rates recognize the costs involved in administering the vaccine, including the additional resources involved with required public health reporting, conducting important outreach and patient education, and spending additional time with patients answering any questions they may have about the vaccine.
• 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.