For certain Medicare patients, Medicare pays an additional payment for  in-home administration of these Part B preventive vaccines:

• COVID-19
• Flu
• Hepatitis B 
• Pneumococcal

COVID-19 Shot Administration

Starting June 8, 2021, Medicare provides an additional payment amount for administering the COVID-19 shot in the home for certain Medicare patients. Visit COVID-19 Payment for more information, including payment conditions and restrictions. 

Flu, Hepatitis B, & Pneumococcal Shot Administration

Starting January 1, 2024, Medicare provides an additional payment amount for administering flu, hepatitis B, and pneumococcal shots in the home for certain Medicare patients. 

What’s the Payment Amount?

For CY 2024, the additional payment amount for in-home Part B preventive vaccine administration is approximately $38. We pay this amount in addition to the standard administration amount (approximately $30 per flu, hepatitis B, or pneumococcal shot) for a total payment of approximately $68 for a flu, hepatitis B, or pneumococcal shot you administer in a patient's home in CY 2024. 

We also:

• Geographically adjust the additional amount and administration rate based on where you administer the vaccine
• Annually update the additional in-home payment rate for administering Part B preventive vaccines to reflect changes in costs related to administering these vaccines

What Billing Codes Do I Use?

You must use both of these:

• The appropriate CPT code for the flu (G0008), hepatitis B (G0010), or pneumococcal (G0009) vaccine administration
• The HCPCS Level II code M0201 to bill for the additional payment amount for administering the vaccine in the home

When Can I Get the Additional In-Home Payment?

You can get the additional payment for administering flu, hepatitis B, or pneumococcal shots 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 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?

Many types of locations can qualify as a Medicare patient’s home for the additional in-home payment for administering flu, hepatitis B, and pneumococcal B shots, such as:

• A private residence
• Temporary lodging (for example, a hotel or motel, campground, hostel, or homeless shelter)
• An apartment in an apartment complex or a unit in an assisted living facility, group home, or non-Medicaid nursing facility
• Communal spaces of a multi-unit or communal living arrangement
• 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 for these shots:

• Hospitals
• 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 flu, hepatitis B, or pneumococcal shots in the home if the sole purpose of the visit is to administer 1 or more Part B preventive vaccines, including the COVID-19 shot. 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 flu, hepatitis B, or pneumococcal shot at the standard amount (approximately $30 per dose).

Starting January 1, 2024, if you administer a COVID-19, flu, hepatitis B, or pneumococcal shot 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 $30 to administer each flu, hepatitis B, or pneumococcal shot.
• 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. For example, if you give a flu shot and a COVID-19 shot to a patient in 1 home visit, we only pay 1 in-home additional payment. We’ll still pay the administration fee (approximately $30 for the flu, hepatitis B, and pneumococcal shots) for every vaccine dose you give. 
• 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)

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