Financial Increases for COVID-19 Vaccine Administration

Centers for Medicare & Medicaid Services (CMS) announced a reimbursement increase for administering the COVID-19 vaccine.

Effective March 15, 2021, the national average payment rate for physicians, hospitals, pharmacies and other immunizers will be $40 to administer the COVID-19 vaccine.   The increase means an approximate $28 to $40 for the administration of a single-dose vaccine.  For a vaccine requiring two doses will see an increase from approximately $45 to $80 for the administration.

The exact reimbursement amount of the vaccine administration will depend on the type of entity furnishing the vaccinee and geographic adjustments (locality) on where the service will be furnished.

Who pays what for the COVID-19 vaccine:

Medicare:  The Medicare beneficiary has no financial lability.

Medicare Advantage (MA):  Medicare will pay the provider directly if the provider did not receive the COVID-19 vaccine for free.  MA plans must reimburse providers for the administration of the vaccine.  The MA beneficiary has no financial liability.

Medicaid:  State Medicaid must provide the vaccine at no-charge during the public health emergency and at least 1 year after it ends.  The federal government will fully fund the vaccine administration.

Private Insurance:  Private insurance must provide the vaccinee at no cost-sharing to the patient this includes both the vaccine and the administration of the vaccine.  This requirement runs for the duration of the public health emergency.  For out-of-network, the rates must be reasonable.

Uninsured:  Providers who provide vaccine administration to uninsured can submit a claim for reimbursement through the Provider Relief Fund that is administered under the Health Resources and Services Administration (HRSA).

The CMS press release can be found here.