FAQs for The HRSA COVID-19 Coverage Assistance Fund

Health care providers who have administered Food and Drug Administration (FDA) authorized COVID-19 vaccines under an Emergency Use Authorization (EUA) or FDA-licensed COVID-19 vaccines under a Biologics License Application (BLA)to underinsured individuals, can request claims reimbursement through the HRSA COVID-19 Coverage Assistance Fund electronically and will be reimbursed at the national Medicare rate (not geographically adjusted) for the vaccine administration fees, or for patient charges related to COVID-19 vaccination, including co-pays for vaccine administration, deductibles for vaccine administration, and co-insurance, subject to available funding. Steps will involve enrolling as a provider participant, submitting claims, and receiving payment via direct deposit. Prior to these steps, the provider must submit a claim for vaccine administration to the individual’s health plan for payment and have the claim denied or only partially paid.

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.

To enroll in the program, providers should visit the HRSA Coverage Assistance Fund site. Providers will click on the Provider Enrollment Link and navigate to the account creation page to begin enrollment.

Providers will be prompted to, and must, attest to the following at the time of enrollment:

• They have submitted a claim to the patient’s primary health insurance plan and there is a remaining balance from that health insurance plan that either does not include COVID-19 vaccination as a covered benefit or covers COVID-19 vaccine administration but with cost-sharing.
• They have verified that no other third party payer will reimburse them for COVID-19 vaccine administration fees for that patient encounter, or other patient charges related to that COVID-19 vaccination, including co-pays for vaccine administration, deductibles for vaccine administration, and co-insurance.
• They will accept defined program reimbursement as payment in full.
• They agree not to balance bill the patient.
• They agree to program terms and conditions and may be subject to post-reimbursement audit review.

Once enrolled in the HRSA COVID-19 Coverage Assistance Fund, eligible providers (including eligible pharmacies) can submit claims through their current clearinghouse or submit a claim electronically or manually through the provider portal.

All claims submitted must be complete and final and no interim bills or corrected claims will be accepted. There will be no adjustments to payment once claims reimbursements are made.

• First and last name
• Date of birth
• Gender
• Date of service
• Primary insurance information and policy number
• Address*
• Middle initial (optional)
• Patient account number (optional)

*If the individual is unable or unwilling to provide their address, please add the address of the facility where the care was provided or other location that may be appropriate (e.g., shelter).

No. A provider does not need an individual’s Social Security Number to submit a claim for reimbursement to the CAF.

Yes, for the HRSA COVID-19 Coverage Assistance Fund, claims must be submitted within 365 calendar days from the date of service. All claims are subject to available funding.

If a claim was submitted to the HRSA COVID-19 Uninsured Program and the patient was actually insured, the provider should receive a notice that the claim was not eligible for reimbursement.

Prior to submitting a claim to the Coverage Assistance Fund, the provider should submit a claim for vaccine administration to the individual’s health insurance plan for payment.  The provider can submit the claims to the HRSA COVID-19 Coverage Assistance Fund for claims for COVID-19 vaccine administration provided to individuals who have health insurance, but whose health plan either does not include COVID-19 vaccination as a covered benefit or covers COVID-19 vaccine administration but with cost-sharing. Only those COVID-19 vaccine administration claims denied or not fully paid by a patient’s health insurance plan, including those insurance plans with patient co-pays for vaccine administration, deductibles for vaccine administration, and co-insurance related to the Covid-19 vaccination, are eligible for reimbursement.

COVID-19 vaccines are free to all individuals living in the US. No patient should be billed directly for fees associated with administering COVID-19 vaccines. Patients may be asked for their insurance information at the time they complete their paperwork to receive the COVID-19 vaccine. During this time, patients may confirm that their provider will be billing their insurance company or the federal government (Medicare, Medicaid, the HRSA CAF or HRSA COVID-19 Uninsured Program) for any associated vaccine administration fee.

Patients should note that currently, all providers and facilities participating in the CDC COVID-19 Vaccination Program (which currently includes any providers who may be administering vaccine to them) :

• must administer COVID-19 Vaccine regardless of the vaccine recipient’s ability to pay COVID-19 vaccine administration fees or insurance coverage status;
• may seek appropriate reimbursement from a program or plan that covers COVID-19 vaccine administration fees for the vaccine recipient; and
• may not seek any reimbursement, including through balance billing, from the vaccine recipient.

If a patient was previously billed for COVID-19 vaccine administration fees and the provider then received reimbursement from either the HRSA COVID-19 Uninsured Program or the HRSA COVID-19 Coverage Assistance Fund program, that provider must refund amounts paid by the patient.

Yes. Health care providers are not required to confirm immigration status prior to submitting claims for reimbursement to the CAF. Health care providers who have administered Food and Drug Administration (FDA) authorized COVID-19 vaccines under an Emergency Use Authorization (EUA) or FDA-licensed COVID-19 vaccines under a Biologics License Application (BLA) to an underinsured individual for dates of service or admittance on or after December 14, 2020, are eligible for claims reimbursement through the program as long as the service(s) provided meet the coverage and billing requirements established as part of the program.

Payments received from the program are claims reimbursements and should be treated in the same manner as reimbursements received from commercial insurance, Medicaid, and/or Medicare, including in how revenue or losses are determined. See guidance issued by the Centers for Medicare & Medicaid Services (PDF - 1 MB) on how providers should report claims reimbursed through the HRSA COVID-19 Coverage Assistance Fund on the S-10 worksheet.

No. These are claims reimbursements, not loans, to health care providers, and will not need to be repaid, provided applicable terms and conditions are met or if it is later determined that the payments were made to ineligible providers or for ineligible beneficiaries or costs.

Yes. The program reimburses providers for COVID-19 vaccine administration fees for underinsured individuals; therefore, any money collected from the individual must be returned to the individual if the provider received funding for that patient through this program.
This requirement is included in the Terms and Conditions that the provider signs in order to enroll in the program.

No. All claims submissions and claims reimbursements must be submitted and remitted electronically.

Providers who self-identify an overpayment can send a check to return the funds. Providers must complete this form (PDF - 94 KB) and include it with their check to ensure funds are applied appropriately. Checks should be made payable to HRSA COVID-19 CAF and submitted with any supporting documentation.

Send Checks/Forms for Returned Funds to:
Provider Relief Bureau
Coverage Assistance Fund
Health Resources and Services Administration
5600 Fishers Lane
Mail Hub 9N34
Rockville, MD 20857