Medicare Payment for COVID-19 Vaccine Increased

Situation Report | March 22, 2021

The U.S. Centers for Medicare and Medicaid Services (CMS) announced that it is increasing the Medicare payment amount for administering the COVID-19 vaccine. 

Effective for COVID-19 vaccines administered on or after March 15, 2021, the national average payment rate for physicians, hospitals, pharmacies and many other immunizers will be $40 to administer each dose of a COVID-19 vaccine. This represents an increase from approximately $28 to $40 for the administration of single-dose vaccines, and an increase from approximately $45 to $80 for the administration of COVID-19 vaccines requiring two doses.

The exact payment rate for administration of each dose of a COVID-19 vaccine will depend on the type of entity that furnishes the service and will be geographically adjusted based on where the service is furnished. 

For calendar years 2020 and 2021, Medicare will pay providers directly for the COVID-19 vaccine (if they do not receive it for free) and its administration for beneficiaries enrolled in Medicare Advantage (MA) plans. MA plans are not responsible for paying providers to administer the vaccine to MA enrollees during this time.

More information on Medicare payment for COVID-19 vaccine administration — including a list of billing codes, payment allowances and effective dates — is available on the CMS website.