CMS Boosts Payments for At-Home COVID-19 Vaccinations

The Centers for Medicare & Medicaid Services (CMS) recently passed a significant policy that helps remove barriers for homebound patients to receive COVID-19 vaccines.

Recognizing the challenge of providing vaccines to medically-complex patients in their homes, CMS increased its payments for this service. Medicare will pay an additional $35 per dose for COVID-19 vaccine administration in a beneficiary’s home, bolstering the total payment from approximately $40 to $75 per vaccine dose. For a two-dose vaccine, this results in a total reimbursement of around $150 for administering both doses, an increase of $70.

To qualify for this payment, vaccines must be administered in a private residence, temporary lodging (e.g., hotel or homeless shelter), apartment complex, unit in an assisted living or group home, or in the home of a Medicare beneficiary who is in a Hospital at Home program.

Important Notes:

• Use HCPCS code M0201 for the additional reimbursement.
• For details on restrictions and billing, click here.
• CMS will only pay the extra fee once per home per date of service.
• You cannot bill for the added charge if you are providing other services, as CMS requires the sole purpose of the visit to be to administer the COVID-19 vaccine.
• For guidance on the protocols for vaccinating patients at home, healthcare providers can refer to the CDC’s Vaccinating Homebound Persons with COVID-19. Patients or caregivers looking for a vaccine can visit vaccines.gov or vacunas.gov (Spanish) or call 800-232-0233 (TTY: 888-720-7489) for assistance in English and Spanish.