CMS updates COVID-19 vaccine pricing for 2026‒2027 season
CMS recently released its 2026‒2027 seasonal influenza and COVID-19 vaccine pricing file, providing updated Part B payment allowances for several COVID-19 vaccine products.
The file now includes the following Current Procedural Terminology (CPT®) product codes and payment allowances for COVID-19 vaccines, effective August 27, 2026:
- 91304 (Novavax): $232.218
- 91319 (Pfizer): $103.330
- 91320 (Pfizer): $230.405
- 91321 (Moderna): $172.967
- 91322 (Moderna): $172.967
- 91323 (Moderna): $252.225
COVID-19 vaccines are covered as preventive vaccines under Part B. When billing these claims, code selection should be based on the vaccine product, formulation, dose, patient age, and date of service.
COVID-19 vaccine claims should also include the appropriate administration code(s). CPT code 90480 is used to report the administration of a single-dose COVID-19 vaccine via intramuscular injection, and its payment allowance for the 2026‒2027 season remains at $44.95.
When a COVID-19 vaccine is administered in a patient’s home, and applicable requirements are met, both CPT code 90480 and Healthcare Common Procedure Coding System (HCPCS) code M0201 should be reported on the claim. HCPCS code M0201 can only be reported once per Medicare patient per date of service, even if the provider administers more than one Part B preventive vaccine in the same visit. The payment allowance for HCPCS code M0201 remains at $39.90.
Revenue integrity teams should continue to monitor CMS’ vaccine pricing web page, as the agency stated it will update the file periodically as more pricing information becomes available. CMS also posted a crosswalk with updated National Drug Codes for the 2026‒2027 season.