Situation Report | June 14, 2021
The U.S. Centers for Medicare and Medicaid Services (CMS) last week announced an increase in payments for administering COVID-19 vaccinations to Medicare beneficiaries at home.
CMS says it will now pay an additional $35 per dose for COVID-19 vaccine administration in a beneficiary’s home, increasing the total payment amount from approximately $40 to approximately $75 per vaccine dose.
For a two-dose vaccine, this results in a total payment of approximately $150 for the administration of both doses, or approximately $70 more than the current rate.
CMS says the new amount accounts for monitoring time as well as the “upfront costs associated with administering the vaccine safely and appropriately in a beneficiary’s home.” The rate will also be geographically adjusted based on where the service is furnished.
HCA has called for increased reimbursement in a recent paper consisting of input and experiences from a roundtable of home care providers who have been administering vaccinations in the home. That paper was shared with our partners at the National Association for Home Care and Hospice (NAHC) and later presented to White House officials as HCA and NAHC work to enhance supports for in-home vaccination efforts.
HCA’s advocacy on this issue has also resulted in an increase in Medicaid payment for vaccine administration and solidified state efforts to target vaccinations to homebound individuals (see further information below).
See here for more information on Medicare payment for COVID-19 vaccine administration, including a list of billing codes, payment allowances and effective dates.
CMS’s press release provides additional information about billing other payors. It emphasizes that the federal government is providing free access to COVID-19 vaccines for every adult living in the U.S. and no patient can be billed for COVID-19 vaccinations.
CMS Resource for Billing Medicare
CMS has also posted an information sheet with details about how to bill Medicare for COVID-19 vaccinations at home, including Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes as well as procedures for roster billing.
Reminder: DOH, NYSOFA Post Local Points of Contact for Homebound Vaccinations
As a reminder, the state Department of Health has issued an announcement, in partnership with counties and the New York State Office for the Aging (NYSOFA), identifying local points of contact to help expand access to vaccines through an in-home vaccination program for homebound New Yorkers.
This resource can be shared with your patients or staff. It is designed to help individuals who are considered homebound.
HCA Survey Seeks Input on Home Care Vaccinations: Due 6/18
HCA also reminds members that we are seeking input from home care agencies on their plans to encourage and further improve the vaccination rates of home care workers and patients across the state.
This brief, thirteen-question survey will take approximately five minutes to complete, and responses are due by close of business on Friday, June 18.
All responses are confidential and will only be reported in the aggregate. If you operate more than one agency type, please submit a separate survey for each agency.