CMS raises some COVID-19 vaccine payments as HHS issues reminder of billing rules

Wednesday, June 16, 2021

CMS boosted Medicare payment for COVID-19 vaccines administered in the patient’s home to $75 per dose, the agency announced June 9. Prior to June 9, Medicare paid $40 per dose for COVID-19 vaccines administered in the patient’s home.

The increase in payment is intended to help incentivize organizations to develop or expand vaccination programs for Medicare beneficiaries who are homebound or are otherwise hard to reach, CMS said. It is also meant to help cover the additional resources required to safely administer vaccines in patients’ homes.

Organizations receive COVID-19 vaccines for free from the federal government and can only bill payers for administration. Organizations cannot charge Medicare or Medicaid beneficiaries for COVID-19 vaccine administration. Most private health insurers are required to provide the vaccination to their beneficiaries with no out-of-pocket costs. However, recent reports indicate that some organizations are billing patients for COVID-19 vaccine administration.

In light of these reports, HHS reminded organizations that they are legally obligated to provide coverage of COVID-19 vaccines and diagnostic testing at no charge to patients.

COVID-19 vaccines are free for all individual living in the United States, regardless of their insurance or immigration status, HHS said in its statement. Organizations may be reimbursed for administration through Medicare, Medicaid, private insurance, or other coverage. Most health plans and insurers are legally required to cover COVID-19 vaccines with no beneficiary cost-sharing.

Organizations may bill the Health Resources and Services Administration COVID-19 Uninsured and COVID-19 Coverage Assistance Fund programs for administration of vaccines provided to uninsured or underinsured individuals.

Any payments received from patients for COVID-19 vaccines must be immediately refunded, HHS said. Organizations that fail to do so may be reported to the Office of Inspector General and may face additional actions for failure to comply with the Center for Disease Control’s COVID-19 Vaccination Program Provider Agreement.

In March, NAHRI’s Professional Advocacy Committee published guidance on billing for COVID-19 vaccines. The guidance addresses coverage, coding, and billing concerns related to COVID-19 vaccines.

Editor’s note: See additional NAHRI coverage of COVID-19 vaccines and reimbursement here.