CMS expands Medicare payments for at-home COVID-19 vaccinations

Wednesday, September 8, 2021

CMS is expanding payments for at-home COVID-19 vaccinations to include communal spaces in multi-unit living settings or communal arrangements, according to an August 24 press release. Vaccines provided to residents of assisted living facilities participating in the CDC’s Pharmacy Partnership for Long-Term Care Program will also be eligible for the additional payment.

The total Medicare payment for a COVID-19 vaccine, including second and third doses, administered in a beneficiary’s home is approximately $75 per dose. The payment boost is intended to incentivize providers to bring vaccines to traditionally hard to reach individuals, such as homebound individuals, who are also often at greater risk of hospitalization if they contract COVID-19.

This most recent change to CMS’ at-home COVID-19 vaccination payment policy is aimed at reaching individuals in smaller group homes and group living facilities who are homebound or access-challenged. Providers will be able to receive the increased payment up to five times when fewer than 10 Medicare beneficiaries are vaccinated on the same day in the same home or communal living setting.

For additional information on how at-home COVID-19 vaccination payments are calculated, see CMS’ Medicare COVID-19 Vaccine Shot Payment webpage. Coding and billing instructions can be found on CMS’ Coding for COVID-19 Vaccine Shots webpage and Billing for COVID-19 Vaccine Shot webpage.

Editor’s note: See additional NAHRI coverage of COVID-19 vaccine payments, billing, and coding here.

Found in Categories: 
Billing and Claims, News, Revenue Integrity

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