COVID-19 Vaccine Administration Rates Adjusted

The Centers for Medicare and Medicaid Services (CMS) announced it is updating the Medicare payment rates for COVID-19 vaccine administration. Effective for services furnished on or after March 15, 2021, the new rate will be approximately $40 to administer each dose of a COVID-19 vaccine. This represents an increase from approximately $28 to $40 for a single-dose vaccine, and $45 to $80 for vaccines requiring two doses. Exact payment rates depend on the type of entity furnishing the service and will be geographically adjusted based on where the service is furnished. To read more, click here. It is important to note that Medicare vaccine administration payment for FQHCs at the current time will still occur retroactively with the cost report. Also, whether this CMS payment change will also result in a payment increase by Medicaid is still being evaluated by the PA Department of Human Services (DHS). As shared previously, DHS is working on an FQHC/RHC-specific COVID-19 vaccine payment bulletin which has not yet been released but has shared some of the payment policy it will implement with PACHC:

  • For fee-for-service (FFS) billing, PROMISe has been updated to allow FQHCs/RHCs to bill using the administrative codes identified in bulletin Medical Assistance Bulletin 01-20-59, Addition to the Medical Assistance Program Fee Schedule for Administration of SARS-CoV-2 Vaccines. DHS directs that you use your PT/Spec and POS.
  • For HealthChoices Medicaid managed care plans, you will need to check with your contracted MCOs on how to bill.
  • DHS is in the process of requesting CMS approval to use an alternate payment methodology (APM) for all COVID-19 vaccines administered outside of defined requirements for a T1015 visit/encounter billing. (PACHC Note: In other words, if a vaccination visit meets the definition of eligible FQHC/RHC encounter the visit is billable as a PPS encounter and you do not bill for the vaccine administration separately). The APM would pay vaccinations that are not part of an eligible FQHC encounter at Medicare rates.
  • DHS is directly reimbursing the MCOs for the cost of vaccine administration and expects that MCOs will reimburse at least what DHS is reimbursing. However, FQHCs need to check with each of your MCOs on how they will handle vaccine administrative billing.