Medicare Payment Rates

These rates reflect updated information about the costs involved in administering the COVID-19 vaccine for different types of providers and the additional resources you need to safely and appropriately administer the vaccine.

For all COVID-19 vaccine administration payment rates, we also:

• Geographically adjust the rates based on where you administer the vaccine
• Annually update the COVID-19 vaccine administration payment rates starting January 1, 2023, to reflect changes in costs related to administering preventive vaccines

Get the most current list of billing codes, payment allowances and effective dates.

Payment Rates After the PHE Ends

We’ll continue to pay these rates for administering COVID-19 vaccines through the end of the calendar year in which the current emergency use authorization (EUA) declaration for COVID-19 drugs and biologicals ends. The EUA declaration is distinct from, and not dependent on, the COVID-19 PHE. Learn more about what happens to EUAs when a PHE ends. During this interim time, we’ll maintain the administration payment amounts when you administer COVID-19 vaccines in health care settings and in the home.

Payment Rates After the EUA Declaration Ends

Effective January 1 of the year following the year in which the EUA declaration for COVID-19 drugs and biologicals ends, we’ll set the payment rate for administering COVID-19 vaccines to align with the payment rate for administering other Part B preventive vaccines ($30 per dose).

Additional Payment for Administering the Vaccine in the Patient’s Home

Effective June 8, 2021, Medicare provides an additional payment amount for administering the COVID-19 vaccine in the home for certain Medicare patients. The end of the PHE didn’t affect this additional payment amount.

For CY 2024, Medicare pays approximately $38 in addition to the standard administration amount (approximately $40 per COVID-19 vaccine dose) for a total payment of approximately $78 for a COVID-19 vaccine dose you administer in a patient's home. We also geographically adjust the additional amount and administration rate based on where you administer the vaccine. Starting January 1, 2023, we also annually update the additional in-home payment rate for administering the COVID-19 vaccine to reflect changes in costs related to administering preventive vaccines.

When Can I Get the Additional In-Home Payment for Administering the COVID-19 Vaccine?

You can get the additional payment for administering the COVID-19 vaccine in a Medicare patient's home when the patient has difficulty leaving the home or faces barriers to getting a vaccine in settings other than their home. For example:

• They have a condition, due to an illness or injury, that restricts their ability to leave home without a supportive device or help from a paid or unpaid caregiver.
• They have a condition that makes them more susceptible to contracting a disease.
• They're generally unable to leave the home. If they do leave home, it requires a considerable and taxing effort.
• The patient is hard-to-reach because they have a disability or face clinical, socioeconomic, or geographical barriers to getting a COVID-19 vaccine in settings other than their home. These patients face challenges that significantly reduce their ability to get vaccinated outside the home, such as challenges with transportation, communication, or caregiving.

Unlike the requirements under the Medicare home health benefit, you or another allowed practitioner don’t need to certify that the Medicare patient is homebound. But, you must document in the patient’s medical record their clinical status or the barriers they face to getting the vaccine outside the home.

What Locations Qualify for the Additional In-Home Payment?

Many types of locations can qualify as a Medicare patient’s home for the additional in-home payment amount, such as:

• Private residence
• Temporary lodging (for example, a hotel or motel, campground, hostel, or homeless shelter)
• Apartment in an apartment complex or a unit in an assisted living facility, group home, or non-Medicaid nursing facility
• Patient’s home that was made provider-based to a hospital during the COVID-19 PHE
• Effective August 24, 2021, communal spaces of a multi-unit or communal living arrangement
• Effective August 24, 2021, assisted living facilities participating in the CDC Pharmacy Partnership for Long-Term Care Program when you vaccinate their residents through this program

These locations don’t qualify as a home for the additional payment amount:

• Before August 24, 2021, communal spaces of a multi-unit living or communal arrangement
• Hospitals (except when the Medicare patient’s home was made provider-based to a hospital during the COVID-19 PHE)
• Medicare skilled nursing facilities and Medicaid nursing facilities, regardless of whether they’re the patient’s permanent residence

What Other Restrictions Apply?

Medicare only pays the additional amount for administering the COVID-19 vaccine in the home if the sole purpose of the visit is to administer 1 or more Part B preventive vaccines (including the COVID-19 vaccine). Medicare doesn’t pay the additional amount if you provide another Medicare service in the same home on the same date. In those situations, Medicare pays for administering the COVID-19 vaccine at the standard amount (approximately $40 per dose).

If you administer Part B preventive vaccines, including the COVID-19 vaccine, to more than 1 Medicare patient in a single home in the same multi-unit or communal living arrangement on the same day:

• Medicare pays approximately $40 to administer each dose of the COVID-19 vaccine, including additional doses and booster doses.
• For dates of service starting January 1, 2024, Medicare pays the additional payment amount (approximately $38 in CY 2024) only once per patient per date of service in that home, even if you administer other Part B preventive vaccines (flu, hepatitis B, or pneumococcal) during the home visit. For example, if you give a COVID-19 shot and a flu shot to a patient in 1 home visit, we only pay 1 in-home additional payment. We’ll still pay the administration fee (approximately $40 for the COVID-19 vaccine in CY 2024) for every COVID-19 vaccine dose you give. 
• Starting August 24, 2021, Medicare pays the additional payment amount (approximately $38 per dose administered for CY 2024) for up to a maximum of 5 vaccine administration services per home unit or communal space within a single group living location.
  • You can bill for up to 5 vaccine administration services only when fewer than 10 Medicare patients get a vaccine dose on the same day at the same group living location
  • When 10 or more Medicare patients get a vaccine dose at a group living location on the same day, you can only bill for the additional payment once per home (whether the home is an individual living unit or a communal space)
• For dates of service from June 8, 2021 - August 23, 2021, Medicare paid the additional payment amount of approximately $35 only once per date of service in that home regardless of how many Medicare patients got the vaccine.

Examples:

¹Includes a communal space in a group living situation
²Could be an individual living unit or a communal space in a group living situation
³You can only bill for 1 home add-on payment in this situation because you vaccinated 10 or more Medicare patients at the same group living location on the same date
⁴In other words, each vaccine administered in a distinct individual living unit or communal space of a group living situation