March 16, 2021
The Centers for Medicare and Medicaid Services announced Monday that it would double Medicare payment for administration of the COVID-19 vaccine. Effective for COVID-19 vaccines administered on or after March 15, 2021, the national average payment rate for physicians, hospitals, pharmacies and many other immunizers will be $40 to administer each dose of a COVID-19 vaccine. This represents an increase from approximately $28 to $40 for the administration of single-dose vaccines, and an increase from approximately $45 to $80 for the administration of COVID-19 vaccines requiring two doses.
This payment increase follows significant advocacy by the American Medical Association (AMA), the California Medical Association (CMA) and others who have been urging the Biden Administration to increase payment to ensure adequate reimbursement for the administration of these life-saving vaccines for Medicare patients, while ensuring there are no out-of-pocket costs for patients.
The updated Medicare payment rate reflects the additional resources necessary to ensure the vaccine is administered safely and appropriately. These costs are described by the CPT Editorial Panel with the new CPT code 99072 and are now bundled into the new COVID-19 immunization administration payments.
This new and higher payment rate will also support important actions taken by providers that are designed to increase the number of vaccines they can furnish each day, including establishing new or growing existing vaccination sites, conducting patient outreach and education, and hiring additional staff.
At a time when vaccine supply is growing, CMS is supporting provider efforts to expand capacity and ensure that all Americans can be vaccinated against COVID-19 as soon as possible.