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Last Modified: 7/28/2022 Location: FL, PR, USVI Business: Part A, Part B

Billing for COVID-19 vaccine home administration

Effective for claims received on and after June 8, 2021, Medicare will pay an additional amount of $35 per dose for administering the COVID-19 vaccine in the home for certain Medicare patients that have difficulties leaving their home or are hard to reach. This payment also applies when additional doses of the COVID-19 vaccine are administered in the home to certain Medicare patients for dates of service (DOS) on or after August 12, 2021. Medicare only pays the additional amount for administering the COVID-19 vaccine in the home if the sole purpose of the visit is to administer a COVID-19 vaccine. Medicare doesn’t pay the additional amount if you provide another Medicare service in the same home on the same date.
Note: 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. CMS provides guidance for billing and payment examples on the Medicare billing for COVID-19 vaccine shot administration webpage external link.

Billing

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.
For DOS between June 8, 2021, and August 24, 2021:
Medicare pays the additional payment only once per DOS in that home regardless of how many Medicare patients receive the vaccine.
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.
For Part B, the place of service codes eligible for the add-on payment include:
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.
Add condition code 78 for Medicare Advantage claims for beneficiary claims submitted to Original Medicare for dates of service in 2020 and 2021.

Roster billing

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.
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.