Vaccine Pricing

CMS monitors the public domain and looks for alerts from CDC for new vaccine products. When a new product enters the market, manufacturers should notify CMS at sec303aspdata@cms.hhs.gov.

Medicare Part B covers the following types of vaccines and their administration:

  • Preventive vaccines specified in statute: Examples include the Influenza, COVID-19, Pneumococcal, and Hepatitis B vaccines, which are used to prevent illness
  • Vaccines used for treatment: Examples include the Tetanus, Rabies, and Hepatitis A vaccines, which are used as treatment after exposure to an illness

 

Table 1: Information on Payment for Part B Vaccine Products
VaccinePayment MethodologyTimingAdditional Information
Influenza•    95% of the Average Wholesale Price (AWP)
•    In certain settings, such as in hospital outpatient departments, hospital based Rural Health Clinics (RHC), and Federally Qualified Health Clinics (FQHC), payment is based on reasonable cost.
 
Payment limits are established annually and are effective from August 1 to July 31 of the following year.Visit the Seasonal Influenza section below for more information.
COVID-19•    95% of AWP
•    In certain settings, such as in hospital outpatient departments, hospital based RHCs, and FQHCs, payment is based on reasonable cost.
 
Payment limits are updated annually.Visit the COVID-19 section below for more information. 
Pneumococcal•    95% of AWP
•    In certain settings, such as in hospital outpatient departments, hospital based RHCs, and FQHCs, payment is based on reasonable cost.
 
Payment limits updated quarterly.Refer to the Average Sales Price (ASP) pricing files for current payment limits.
Hepatitis B•    95% of AWP
•    In certain settings, such as in hospital outpatient departments, hospital based RHCs, and FQHCs, payment is based on reasonable cost.
 
Payment limits updated quarterly.Refer to the ASP pricing files for current payment limits
 
Vaccines Used for TreatmentGenerally,106 percent of ASPPayment limits updated quarterly.Refer to the ASP pricing files for current payment limits

Seasonal Influenza Pricing

Part B deductibles and coinsurance don’t apply for flu vaccine products or their administration. With respect to vaccine products, all providers and suppliers must accept assignment on the claim. The annual flu vaccine season is August 1 through July 31 of the following year. Find more information at Frequency & Coverage, Billing and Coding.

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

CPT Code or HCPCS code

CPT or HCPCS Short Descriptor

Labeler Name

Vaccine/Procedure Name

National Payment Allowance

Effective Dates

90653

IIV ADJUVANT VACCINE IM

Seqirus

Fluad Trivalent (2024/2025) Preservative Free

$83.490

08/01/2024-07/31/2025

90656

IIV3 VACC NO PRSV 0.5 ML IM

Seqirus

Afluria Trivalent (2024/2025)  Preservative Free

$22.350

08/01/2024-07/31/2025

Sanofi Pasteur

Fluzone Trivalent (2024/2025)  Preservative Free

08/01/2024-07/31/2025

GlaxoSmithKline

Fluvarix Trivalent (2024/2025) Preservative Free

08/01/2024-07/31/2025

FluLaval Trivalent (2024/2025) Preservative Free

08/01/2024-07/31/2025

90657

IIV3 VACCINE SPLT 0.25 ML IM

Seqirus

Afluria Trivalent (2024/2025)

Pediatric Dose

$10.929

08/01/2024-07/31/2025

Sanofi Pasteur

Fluzone Trivalent (2024/2025) 

Pediatric Dose

08/01/2024-07/31/2025

90658

IIV3 VACCINE SPLT 0.5 ML IM

Seqirus

Afluria Trivalent (2024/2025)

$21.858

08/01/2024-07/31/2025

Sanofi Pasteur

Fluzone Trivalent (2024/2025) 

08/01/2024-07/31/2025

90660

LAIV3 VACCINE INTRANASAL

MedImmune

FluMist Trivalent (2024/2025)

$28.871

08/06/2024-07/31/2025

90661

CCIIV3 VAC ABX FR 0.5 ML IM

Seqirus

Flucelvax Trivalent (2024/2025) Preservative Free

$36.849

08/01/2024-07/31/2025

Flucelvax Trivalent (2024/2025)

08/01/2024-07/31/2025

90662

IIV NO PRSV INCREASED AG IM

Sanofi Pasteur

Fluzone High-Dose Trivalent (2024/2025) Preservative Free

$83.492

08/01/2024-07/31/2025

90673

RIV3 VACCINE NO PRESERV IM

Sanofi Pasteur

Flublok Trivalent (2024/2025)

Preservative Free

$83.492

08/01/2024-07/31/2025

Q2039

INFLUENZA VIRUS VACCINE, NOT OTHERWISE SPECIFIED

N/A

N/A

N/A

08/01/2024-07/31/2025

G0008

ADMIN OF FLU VACCINE

N/A

Administration of influenza virus vaccine

Please see links below for 

Locality-Adjusted Payment Rates

M0201

FLU VACCINE HOME ADMIN

N/A

Administration of influenza vaccine inside a patient's home; reported only once per individual home per date of service when such vaccine administration(s) are performed at the patient's home

Please see links below for 

Locality-Adjusted Payment Rates

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

2025 Locality-Adjusted Payment Amounts for Administration of Influenza, Pneumonia, Hepatitis B Vaccines & In-Home Additional Payment for Download

2025 Geographically-Adjusted Payment Rates for Influenza, Pneumococcal, Hepatitis B and COVID-19 Vaccine Administration & In-Home Additional Payment (ZIP) [For claims with dates of service 1/1/2025-12/31/2025]

COVID-19 Vaccines & Monoclonal Antibodies

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

CY 2025 COVID-19 Vaccines  (DOS - Date of Service; TBD - To Be Determined)

 

CPT Code or HCPCS Code

CPT or HCPCS Short DescriptorLabeler NameVaccine/Procedure NameNational Payment Allowance Effective for Claims with DOS on or after 03/15/2021Effective Dates for Medicare Payment
90480ADMN SARSCOV2 VACC 1 DOSEN/AN/A$44.95[2]09/11/2023 - TBD
M0201Covid-19 vaccine home adminHome vaccine adminCovid-19 vaccine administration inside a patient's home; reported only once per individual home per date of service when only covid-19 vaccine administration is performed at the patient's home$39.90[2]06/08/2021 - TBD
91304SARSCOV2 VAC 5MCG/0.5ML IMNovavaxNovavax Covid-19 Vaccine, Adjuvanted (Aged 12 years and older) 2024-2025 Formula$ 161.538 08/30/2024 – TBD
91318SARSCOV2 VAC 3MCG TRS-SUCPfizer-BioNTechPfizer-BioNTech COVID-19 Vaccine 2024-2025 Formula (Yellow Cap)$65.550

08/22/2024  - TBD

 

91319SARSCV2 VAC 10MCG TRS-SUC IMPfizer-BioNTechPfizer-BioNTech COVID-19 Vaccine 2024-2025 Formula (Blue Cap)$87.78008/22/2024  - TBD
91320SARSCV2 VAC 30MCG TRS-SUC IMPfizer-BioNTechCOMIRNATY (COVID-19 Vaccine, mRNA) 2024-2025 Formula$155.89508/22/2024 - TBD
91321SARSCOV2 VAC 25 MCG/.25ML IMModernaModerna COVID-19 Vaccine 2024-2025 Formula$147.06008/22/2024 - TBD
91322SARSCOV2 VAC 50 MCG/0.5ML IMModernaSPIKEVAX 2024-2025 Formula$161.65208/22/2024 - TBD

 

CY 2024 COVID-19 Vaccines

 

CPT Code or HCPCS Code

CPT or HCPCS Short DescriptorLabeler NameVaccine/Procedure NameNational Payment Allowance Effective for Claims with DOS on or after 03/15/2021Effective Dates for Medicare Payment
90480ADMN SARSCOV2 VACC 1 DOSEN/AN/A$40.000[2]09/11/2023 - TBD
M0201Covid-19 vaccine home adminHome vaccine adminCovid-19 vaccine administration inside a patient's home; reported only once per individual home per date of service when only covid-19 vaccine administration is performed at the patient's home$35.50[2]06/08/2021 - TBD
91304SARSCOV2 VAC 5MCG/0.5ML IMNovavaxNovavax Covid-19 Vaccine, Adjuvanted (Aged 12 years and older) 2023-2024 Formula$ 148.20007/13/2022 – 08/29/2024
91318SARSCOV2 VAC 3MCG TRS-SUCPfizer-BioNTechPfizer-BioNTech COVID-19 Vaccine 2023-2024 Formula (Yellow Cap)$65.550

09/11/2023 - 8/21/2024

 

91319SARSCV2 VAC 10MCG TRS-SUC IMPfizer-BioNTechPfizer-BioNTech COVID-19 Vaccine 2023-2024 Formula (Blue Cap)$87.78009/11/2023 - 8/21/2024
91320SARSCV2 VAC 30MCG TRS-SUC IMPfizer-BioNTechCOMIRNATY (COVID-19 Vaccine, mRNA) 2023-2024 Formula$131.10009/11/2023 – 8/21/2024
91321SARSCOV2 VAC 25 MCG/.25ML IMModernaModerna COVID-19 Vaccine 2023-2024 Formula$145.92009/11/2023 – 8/21/2024
91322SARSCOV2 VAC 50 MCG/0.5ML IMModernaSPIKEVAX 2023-2024 Formula$145.92009/11/2023 – 8/21/2024

Geographically Adjusted Payment Rates for 2025

2025 Geographically-Adjusted Payment Rates for COVID-19 Vaccine Administration & In-Home Additional Payment (ZIP) [For claims with dates of service 1/1/2025-12/31/2025]
 

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

HCPCS CodeHCPCS Short DescriptorLabeler NameVaccine/Procedure NameNational Payment Allowance Effective for Claims with DOS on or after 05/6/2021National Payment Allowance Effective for Claims with DOS through 05/5/2021Effective Dates

Q0220

Note: This product isn’t currently authorized[12]

Tixagev and cilgav, 300mgAstraZenecaInjection, tixagevimab and cilgavimab, for the pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available covid-19 vaccine is not recommended due to a history of severe adverse reaction to a covid-19 vaccine(s) and/or covid-19 vaccine component(s), 300 mg$0.010[1]Code not active during this time period12/08/2021 - TBD

Q0221

Note: This product isn’t currently authorized[12]

Tixagev and cilgav, 600mgAstraZenecaInjection, tixagevimab and cilgavimab, for the pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available covid-19 vaccine is not recommended due to a history of severe adverse reaction to a covid-19 vaccine(s) and/or covid-19 vaccine component(s), 600 mg$0.010[1]Code not active during this time period02/24/2022 - TBD

M0220

Note: This product isn’t currently authorized[12]

Tixagev and cilgav injAstraZenecaInjection, tixagevimab and cilgavimab, for the pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available covid-19 vaccine is not recommended due to a history of severe adverse reaction to a covid-19 vaccine(s) and/or covid-19 vaccine component(s), includes injection and post administration monitoring$150.50[3]Code not active during this time period12/08/2021 - TBD

M0221

Note: This product isn’t currently authorized[12]

Tixagev and cilgav inj hmAstraZeneca

Injection, tixagevimab and cilgavimab, for the pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available covid-19 vaccine is not recommended due to a history of severe adverse reaction to a covid-19 vaccine(s) and/or covid-19 vaccine component(s), includes injection and post administration monitoring in the home or residence; this includes a beneficiary’s home that has been made provider-based to the hospital during the covid-19 public health emergency

 

$250.50[3]Code not active during this time period12/08/2021 - TBD

Q0222

Note: This product isn’t currently authorized[11]

Bebtelovimab 175 mgEli LillyInjection, bebtelovimab, 175 mg$2394.00[1] [1a]Code not active during this time period02/11/2022 - TBD

M0222

Note: This product isn’t currently authorized[11]

Bebtelovimab injectionEli LillyIntravenous injection, bebtelovimab, includes injection and post administration monitoring$350.50[3]Code not active during this time period02/11/2022 - TBD

M0223

Note: This product isn’t currently authorized[11]

Bebtelovimab injection homeEli LillyIntravenous injection, bebtelovimab, includes injection and post administration monitoring in the home or residence; this includes a beneficiary’s home that has been made provider-based to the hospital during the covid-19 public health emergency$550.50[3]Code not active during this time period02/11/2022 - TBD
Q0239Bamlanivimab-xxxxEli LillyInjection, bamlanivimab, 700 mgCode not active during this time period $0.010[1]11/10/2020 – 04/16/2021[4]
M0239Bamlanivimab-xxxx infusionEli LillyIntravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoringCode not active during this time period$309.600[3]11/10/2020 – 04/16/2021[4]
Q0240[6]
Note: This product isn’t currently authorized[9]
Casirivi and imdevi 600mgRegeneronInjection, casirivimab and imdevimab, 600 mg$0.010[1]Code not active during this time period07/30/2021 – TBD
M0240[6]
Note: This product isn’t currently authorized[9]
Casiri and imdev repeatRegeneronIntravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring, subsequent repeat doses$450.00[3]Code not active during this time period07/30/2021 – TBD
M0241[6]
Note: This product isn’t currently authorized[9]
Casiri and imdev repeat hmRegeneronIntravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring in the home or residence, this includes a beneficiary's home that has been made provider-based to the hospital during the covid-19 public health emergency, subsequent repeat doses$750.00[3]Code not active during this time period07/30/2021 – TBD
Q0243
Note: This product isn’t currently authorized[9]
Casirivimab and imdevimabRegeneronInjection, casirivimab and imdevimab, 2400 mg$0.010[1]$0.010[1]11/21/2020 – TBD
M0243
Note: This product isn’t currently authorized[9]
Casirivi and imdevi injRegeneronIntravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring$450.00[3]$309.600[3]11/21/2020 – TBD
Q0244[5]
Note: This product isn’t currently authorized[9]
Casirivi and imdevi 1200 mgRegeneronInjection, casirivimab and imdevimab, 1200 mg$0.010[1]$0.010[1]06/03/2021 – TBD
M0244
Note: This product isn’t currently authorized[9]
Casirivi and imdevi inj hmRegeneronIntravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring in the home or residence; this includes a beneficiary’s home that has been made provider-based to the hospital during the covid-19 public health emergency$750.00[3]Code not active during this time period05/06/2021 – TBD
Q0245[8]
Note: This product isn’t currently authorized
Bamlanivimab and etesevimaEli LillyInjection, bamlanivimab and etesevimab, 2100 mg$0.010[1]$0.010[1]02/09/2021 – TBD
M0245[8]
Note: This product isn’t currently authorized
Bamlan and etesev infusionEli Lillyintravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring$450.00[3]$309.600[3]02/09/2021 – TBD
M0246[8]
Note: This product isn’t currently authorized
Bamlan and etesev infus homeEli LillyIntravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring in the home or residence; this includes a beneficiary’s home that has been made provider-based to the hospital during the covid-19 public health emergency$750.00[3]Code not active during this time period05/06/2021 – TBD

Q0247[7]

Note: This product isn’t currently authorized[10]

SotrovimabGSKInjection, sotrovimab, 500 mg$2394.00Code not active during this time period05/26/2021 – TBD

M0247

Note: This product isn’t currently authorized[10]

Sotrovimab infusionGSKIntravenous infusion, sotrovimab, includes infusion and post administration monitoring$450.00[3]Code not active during this time period05/26/2021 – TBD

M0248

Note: This product isn’t currently authorized[10]

Sotrovimab inf, home adminGSKIntravenous infusion, sotrovimab, includes infusion and post administration monitoring in the home or residence; this includes a beneficiary’s home that has been made provider-based to the hospital during the covid-19 public health emergency$750.00[3]Code not active during this time period05/26/2021 – TBD
Q0249[2]Tocilizumab for COVID-19GenentechInjection, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older) with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) only, 1 mg$7.569Code not active during this time period06/24/2021 - TBA
M0249Adm Tocilizu COVID-19 1stGenentechIntravenous infusion, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older) with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) only, includes infusion and post administration monitoring, first dose$450.00[3]Code not active during this time period06/24/2021 - TBA
M0250Adm Tocilizu COVID-19 2ndGenentechIntravenous infusion, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older) with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) only, includes infusion and post administration monitoring, second dose$450.00[3]Code not active during this time period06/24/2021 - TBA
Q0224Inj, pemivibart, 4500 mgInvivydInjection, pemivibart, for the pre-exposure prophylaxis only, for certain adults and adolescents (12 years of age and older weighing at least 40 kg) with no known SARS-CoV-2 exposure, and who either have moderate-to-severe immune compromise due to a medical condition or receipt of immunosuppressive medications or treatments, and are unlikely to mount an adequate immune response to COVID-19 vaccination, 4500 mg$6,583.50Code not active during this time period03/22/2024 – TBD
M0224Pemivibart infusionInvivydIntravenous infusion, pemivibart, for the pre-exposure prophylaxis only, for certain adults and adolescents (12 years of age and older weighing at least 40 kg) with no known SARS-CoV-2 exposure, who either have moderate-to-severe immune compromise due to a medical condition or receipt of immunosuppressive medications or treatments, includes infusion and post administration monitoring$450.00[3]Code not active during this time period03/22/2024 – TBD

[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.

Geographically Adjusted Payment Rates for 2025

2025 Geographically-Adjusted Payment Rates for Monoclonal Antibody Administration (ZIP) [For claims with dates of service 1/1/2025-12/31/2025]

 

Page Last Modified:
01/16/2025 03:30 PM