Situation Report | August 30, 2021
Effective June 8, 2021, Medicare’s additional payment amount for administering the COVID-19 vaccine in the home for certain Medicare patients is $35 per dose. This payment also applies when additional doses of the COVID-19 vaccine are administered in the home to certain Medicare patients on or after August 12, 2021.
Medicare will pay the $35 amount in addition to the standard administration amount (approximately $40 per COVID-19 vaccine dose), for a total payment of approximately $75 for a vaccine dose administered in a patient’s home. CMS also geographically adjusts the additional amount and administration rate based on where the vaccine is administered.
Providers can get the additional payment for administering the COVID-19 vaccine in Medicare patients’ homes when either of these situations applies:
- The patient has difficulty leaving the home to get the vaccine, which could mean any of these:
- They have a condition, due to an illness or injury, that restricts their ability to leave home without a supportive device or help from a paid or unpaid caregiver
- They have a condition that makes them more susceptible to contracting a pandemic disease like COVID-19
- They are generally unable to leave the home, and if they do leave home it requires a considerable and taxing effort
- The patient is hard-to-reach because they have a disability or face clinical, socioeconomic, or geographical barriers to getting a COVID-19 vaccine in settings other than their home. These patients face challenges that significantly reduce their ability to get vaccinated outside the home, such as challenges with transportation, communication, or caregiving.
Unlike the requirements under the Medicare home health benefit, the provider does not need to certify that the Medicare patient is homebound, but must document in the patient’s medical record their clinical status or the barriers they face to getting the vaccine outside the home.
More information is available on the CMS website.
Medicaid Billing for COVID-19 Vaccines
DOH has updated the billing guidance document regarding Medicaid’s reimbursement policy for the administration of COVID-19 vaccines authorized for emergency use and instructions for providers to bill the cost of administration of authorized COVID-19 vaccines.
It includes billing codes for the third dose of Pfizer and Moderna.
It is at available on the state DOH website.