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.
The payment rates are geographically adjusted. View the 2022
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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