Last Modified: 9/8/2023
Location: FL, PR, USVI
Business: Part A, Part B
In calendar year 2023, CMS will pay approximately $36 in addition to the standard administration amount to administer COVID-19 vaccines in the home for certain Medicare patients. For vaccines requiring multiple doses, this payment applies for each dose in the series, including any additional or booster doses.
Note: The payment rates are geographically adjusted. View the
2022 and
2023 payment rates for COVID-19 vaccine and monoclonal administration.
HCPCS Level II code M0201 (COVID-19 vaccine administration inside a patient's home) is used to bill for the add-on payment..
HCPCS Level II code M0201 for the additional payment for administering the COVID-19 vaccine in the home is billed in addition to one of the COVID -19 vaccine administration CPT codes.
Effective on August 24, 2021:
• Medicare pays the additional payment for up to a maximum of five vaccine administration services per home unit or communal space within a single group living location when:
• Fewer than ten Medicare patients receive a COVID-19 vaccine dose on the same day at the same group living location.
• The additional payment can only be billed once per home whether the home is an individual living unit or a communal space when:
• Ten or more Medicare patients receive a COVID-19 vaccine dose at a group living location on the same day.
• 04, 06, 09, 12, 13, 14, 16, 19, 22, 33, 54, 55, 56 and 60.
For Part A, the type of bill eligible for the add-on payment include:
• 13X, 34X, 72X, 75X, 81X, 82X, and 85X.
If you submit roster bills for administering the COVID-19 vaccine in the home, you must submit two roster bills:
• A roster bill containing the appropriate CPT code for the product and dose-specific COVID-19 vaccine administration
• A second roster bill containing the HCPCS Level II code M0201 for the additional in-home payment amount
You may submit a single set of roster bills (one containing M0201 and another containing the appropriate CPT code) for multiple Medicare patients who get the COVID-19 vaccine in their individual units of a multi-unit living arrangement.
Effective August 24, 2021, when fewer than ten Medicare patients are vaccinated on the same date at the same group living setting, you may submit a roster bill for M0201 for up to a maximum of five Medicare patients in the same home, including for multiple Medicare patients vaccinated in a communal space of the multi-unit living arrangement.
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