Vaccine Pricing

Part B payment allowance limits for seasonal influenza (flu) vaccines (that is, the vaccine product) are 95% of the Average Wholesale Price (AWP). In hospital outpatient departments, payment is based on reasonable cost.

Part B deductible and coinsurance amounts don’t apply for flu vaccine products or their administration. With respect to the vaccine product, all providers and suppliers must accept assignment on the claim.

The annual flu vaccine season is August 1–July 31 of the following year.

Get more information on frequency & coverage, billing, and coding.

Flu Season Payment Allowances & Effective Dates

• Payment Allowances and Effective Dates for the 2024-2025 Flu Season:

Payment limits and effective dates for newly approved and marketed influenza vaccines will be posted to this webpage.

• Payment Allowances and Effective Dates for the 2023-2024 Flu Season:

Payment limits and effective dates for newly approved and marketed influenza vaccines will be posted to this webpage.

• Payment Allowances and Effective Dates for the 2022-2023 Flu Season:

Payment limits and effective dates for newly approved and marketed influenza vaccines will be posted to this webpage.

Locality-Adjusted Payment Rates

• 2024 Locality-Adjusted Payment Rates for Influenza, Pneumococcal, Hepatitis B Vaccine Administration & In-Home Additional Payment (ZIP) [For claims with dates of service 1/1/2024-12/31/2024]
• 2023 Locality-Adjusted Payment Rates for Influenza, Pneumococcal and Hepatitis B Vaccine Administration - For claims with dates of service 1/1/2023–12/31/2023 (ZIP) * Updated 07/14/2023 to reflect locality revisions for Puerto Rico (PR) and the Virgin Islands (VI)
• 2022 Locality-Adjusted Payment Rates for Influenza, Pneumococcal and Hepatitis B Vaccine Administration (For Providers and Suppliers Paid MPFS-Adjusted Rates) – For claims with dates of service 1/1/2022–12/31/2022 (ZIP)
• 2021 Locality-Adjusted Payment Rates for Influenza, Pneumococcal and Hepatitis B Vaccine Administration (For Providers and Suppliers Paid MPFS-Adjusted Rates) – For claims with dates of service 1/1/2021–12/31/2021 (ZIP)

Archive Documents

• Payment Allowances & Effective Dates for the 2020–2021 Flu Season (PDF)
• Payment Allowances & Effective Dates for the 2019–2020 Flu Season (PDF)
• Payment Allowances & Effective Dates for the 2018–2019 Flu Season (PDF)
• Payment Allowances & Effective Dates for the 2017–2018 Flu Season (PDF)

Medicare Part B Payment for COVID-19 Vaccines & Certain Monoclonal Antibodies

This webpage provides the payment allowances and other related information for COVID-19 vaccines and certain monoclonal antibody products. Review the COVID-19 provider toolkit for more information about Medicare and COVID-19 during and after the PHE.

Payment Allowances & Effective Dates for COVID-19 Vaccines & Their Administration: (DOS = Date of Service, TBD = To Be Determined)

2024 – 2025 COVID-19 Vaccines

2023 – 2024 COVID-19 Vaccines

2020 – 2023 COVID-19 Vaccines

^[1] Since we anticipate that providers, initially, won’t incur a cost for the product, CMS will update the payment allowance at a later date. Providers shouldn’t bill for the product if they got it for free.

^[2] We’ll also geographically adjust these rates for many providers. We’ve included files with the geographically adjusted payment rates for COVID-19 vaccine administration in the “Additional Resources” section below. Certain settings use other payment methodologies, such as payment based on reasonable costs. Starting January 1, 2023, we’ll also annually update the COVID-19 vaccine payment rates to reflect changes in costs related to administering preventive vaccines.

^[3] Johnson & Johnson COVID-19 vaccine. On May 5, 2022, the FDA limited the authorized use of the Janssen COVID-19 vaccine. On June 1, 2023, FDA revoked the EUA for this vaccine.

^[4] Administration booster codes should be billed for all applicable booster doses as approved and/or authorized by the FDA.

^[5] On June 17, 2022, FDA authorized the 50MCG/0.5ML presentation of the Moderna COVID-19 vaccine to provide primary series doses in individuals 6 - 11 years of age in addition to the March 29, 2022, FDA authorization to provide booster vaccination doses in individuals 18 years and older.

^[6] On October 12, 2022, the FDA authorized the Moderna bivalent product (dark blue cap with gray border) and its administration for use as a single booster dose in individuals 12 - 17 years old in addition to the August 31, 2022, FDA authorization as a single booster dose in individuals 18 years and older.

Payment Allowances & Effective Dates for COVID-19 Monoclonal Antibodies & Their Administration:

^[1] Providers shouldn't bill for the product if they got it for free through the USG-purchased inventory.

^[1a] Payment rate effective for dates of service on or after August 15, 2022. Providers should only bill Medicare for commercially purchased products.

^[2] Given the limited clinical situations allowed under the EUA, providers should only bill for tocilizumab on a 12x type of bill (TOB).

^[3] We’ll geographically adjust these rates for many providers. We’ve included files with the geographically adjusted payment rates for monoclonal antibody administration in the “Additional Resources” section below. Certain settings use other payment methodologies, such as payment based on reasonable costs.

^[4] On April 16, 2021, the FDA revoked the EUA that allowed for the investigational monoclonal antibody therapy bamlanivimab, when administered alone, to be used for the treatment of mild-to-moderate COVID-19 in adults and certain pediatric patients. As a result, Medicare won't pay for claims with HCPCS codes M0239 or Q0239 with dates of service after April 16, 2021.

^[5] On June 3, 2021, the FDA revised the EUA for casirivimab and imdevimab to change the allowed dosing regimen from 2400 mg to 1200 mg and allow providers to administer the combination product by subcutaneous injection in limited circumstances. As a result, CMS issued a new product code for casirivimab and imdevimab (Q0244) and updated the descriptors for the existing administration codes (M0243/M0244). 

^[6] On July 30, 2021, the FDA revised the EUA for casirivimab and imdevimab to allow its use for post-exposure prophylaxis (PEP) in certain adult and pediatric patients. For patients who meet the criteria for repeat dosing, the authorized dosage is an initial dose of 1200 mg, followed by subsequent repeat dosing of 600 mg once every 4 weeks for the duration of ongoing exposure. As a result, CMS issued a new product code for casirivimab and imdevimab of 600 mg (Q0240) and 2 new codes for the administration of repeat doses of casirivimab and imdevimab (M0240/M0241). Providers who administer casirivimab and imdevimab for PEP should use M0243 or M0244 for administering the first dose and M0240 or M0241 for administering subsequent repeat doses.

^[7] When the government provides monoclonal antibody products to treat COVID-19 for free, providers should only bill for the administration. Don’t include the monoclonal antibody product codes on these claims. If you got the product for free and your systems require a product code to bill for the administration, enter $0.01 for the billed amount.

^[8] On September 16, 2021, the FDA revised the EUA for bamlanivimab and etesevimab administered together, to allow its use for post-exposure prophylaxis (PEP) in certain adult and pediatric patients. Providers should use Q0245 and M0245 or M0246 to bill for administering bamlanivimab and etesevimab for PEP between September 16, 2021 – December 14, 2023. On December 14, 2023, the FDA revoked the EUA for bamlanivimab and etesevimab administered together. 

^[9] On January 24, 2022, the FDA announced that, due to the high frequency of the Omicron variant, REGEN-COV (casirivimab and imdevimab, administered together) isn’t currently authorized in any U.S region. Therefore, you may not administer REGEN-COV for treatment or post-exposure prevention of COVID-19 under the EUA until further notice.

^[10] On April 5, 2022, the FDA announced that, due to the high frequency of the Omicron BA.2 sub-variant, sotrovimab isn’t currently authorized in any U.S. region. Therefore, you may not administer sotrovimab to treat COVID-19 under the EUA until further notice.

^[11] On November 30, 2022, the FDA announced that bebtelovimab isn’t currently authorized in any U.S. region because it isn’t expected to neutralize Omicron sub-variants BQ.1 and BQ.1.1. Therefore, you may not administer bebtelovimab to treat COVID-19 under the EUA until further notice.

^[12] On January 26, 2023, the FDA announced that EVUSHELD isn’t currently authorized for emergency use in the U.S.

COVID-19 Vaccine Resources

• Get HCPCS codes for each product and its administration:
  • COVID-19 CPT vaccine and immunization codes - AMA: View for long, medium, and short descriptions of COVID-19 CPT codes
  • COVID-19 NDC-HCPCS crosswalk
• CDC COVID-19 Vaccination Resources
• COVID-19 Vaccination Training Programs and Reference Materials for Healthcare Professionals
• Information about Public Health Emergency
• COVID-19 Monoclonal Antibodies
• Quick reference guide to the coding structure for COVID-19 vaccine CPT reporting
• COVID-19 provider toolkit: Get more information about Medicare and COVID-19
• Vaccine Authorization Letters & Fact Sheets
  • Moderna
  • Novavax
  • Pfizer-BioNTech
• Monoclonal Antibody EUAs & Fact Sheets for Healthcare Providers
  • ACTEMRA® (tocilizumab): EUA and EUA Fact Sheet 
  • Bamlanivimab: EUA and EUA Fact Sheet
  • Bamlanivimab and etesevimab: EUA and EUA Fact Sheet
  • Bebtelovimab: EUA and EUA Fact Sheet
  • Evusheld^TM (tixagevimab co-packaged with cilgavimab): EUA and EUA Fact Sheet
  • PEMGARDA (pemivibart): EUA and EUA Fact Sheet
  • REGEN-COV® (casirivimab and imdevimab): EUA and EUA Fact Sheet
  • Sotrovimab: EUA and EUA Fact Sheet

Geographically-adjusted Payment Rates

2024

Jan 1 - Dec 2024 Geographically-adjusted Payment Rates for COVID-19 Vaccine Administration & In-Home Additional Payment (ZIP) [For claims with dates of service 1/1/2024-12/31/2024]

Jan 1 - Dec 2024 Geographically-adjusted Payment Rates for Monoclonal Antibody Administration (ZIP)  [For claims with dates of service 1/1/2024-12/31/2024] * Updated 04/02/2024 to reflect the new codes for PEMGARDA [for claims with dates of service 03/22/2024-12/31/2024]

2023

Jan - Dec 2023 Geographically-adjusted Payment Rates for COVID-19 Vaccine Administration (ZIP) [For claims with dates of service 10/03/2023 through 12/31/2023] *Updated 10/05/2023 to remove codes describing the service to administer COVID-19 vaccines that are no longer authorized in the U.S. for the Novavax vaccine, Adjuvanted (effective 10/03/2023)

Jan - Dec 2023 Geographically-adjusted Payment Rates for Monoclonal Antibody Administration (ZIP) [For claims with dates of service 01/01/2023 through 12/31/2023] *Updated 07/14/2023 to reflect locality revisions for Puerto Rico (PR) and the Virgin Islands (VI)

2022

Jan - Dec 2022 Geographically-adjusted Payment Rates for COVID-19 Vaccine Administration (for Providers & Suppliers Paid MPFS-Adjusted Rates) (ZIP) *Updated 12/20/2022 to reflect the new codes for Moderna and Pfizer-BioNTech pediatric bivalent (updated COVID-19 vaccines) booster dose/ third dose [For claims with dates of service 12/08/2022 through 12/31/2022]

Jan - Dec 2022 Geographically-adjusted Payment Rates for Monoclonal Antibody Administration (for Providers & Suppliers Paid MPFS-Adjusted Rates) (ZIP) *Updated 02/17/2022 to reflect the new codes for bebtelovimab [For claims with dates of service 02/11/2022 through 12/31/2022]

2021

Jan - March 2021 Geographically-adjusted Payment Rates for COVID-19 Vaccine Administration (for Providers & Suppliers Paid MPFS-Adjusted Rates) (ZIP) *Updated February 16, 2021 for addition of the COVID-19 Janssen vaccine* [For claims with dates of service of 1/1/2021 through 3/14/2021]

March - Dec 2021 Geographically-adjusted Payment Rates for COVID-19 Vaccine Administration (for Providers & Suppliers Paid MPFS-Adjusted Rates) (ZIP) *Updated 11/02/2021 to account for effective dates for Pfizer-BioNTech COVID-19 Pediatric Vaccine [For claims with dates of service 3/15/2021 through 12/31/2021]

Jan-May 2021 Geographically-adjusted Payment Rates for Monoclonal Antibody Administration (for Providers & Suppliers Paid MPFS-Adjusted Rates) (ZIP) [For claims with dates of service of 1/1/2021 through 5/5/2021]

May-Dec 2021 Geographically-adjusted Payment Rates for Monoclonal Antibody Administration (for Providers & Suppliers Paid MPFS-Adjusted Rates) (ZIP) *Updated 12/23/2021 to account for new codes for tixagevimab co-packaged with cilgavimab* [For claims with dates of service 5/6/2021 through 12/31/2021]