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Last Modified: 8/31/2022 Location: FL, PR, USVI Business: Part A, Part B

2020 payment rates for COVID-19 vaccine and monoclonal administration

The CMS established national payment allowances for the administration of COVID-19 vaccines and monoclonal antibodies. These allowances will be geographically adjusted for many providers. The First Coast allowances for jurisdiction N (JN) for administration of COVID-19 vaccines and monoclonal antibodies for 2020 are as follows:

CODE
Florida LOC 99 (01/02)
Florida LOC 03
Florida LOC 04
Puerto Rico
U.S. Virgin Islands
0001A
16.60
17.35
17.86
17.01
17.01
0002A
27.83
29.07
29.93
28.51
28.51
0011A
16.60
17.35
17.86
17.01
17.01
0012A
27.83
29.07
29.93
28.51
28.51
M0239
297.24
317.12
328.17
311.76
311.76
M0243
297.24
317.12
328.17
311.76
311.76
Access the CMS COVID-19 Vaccines and Monoclonal Antibodies external link webpage for the national allowances and the geographically adjusted rates for other jurisdictions. The files for the geographically adjusted rates can be found under the Additional Resources section.

Provider action

If you received the national, unadjusted payment allowance, you can bring the claim to our attention for reopening to receive the geographically adjusted payment rate. When submitting your request, ensure the billed amount is equal to or higher than the rate to obtain the adjusted rate.
For Part A claims, if you use direct data entry (DDE) for claims submission, you can resubmit your claim to obtain the geographically adjusted rate.
For Part B claims, you can use the SPOT or the Reopening Gateway. To reopen your claim in SPOT or the Reopening Gateway, select the reopening request type Billed Amount and ensure the correct billed amount is present on the line item.
Note for Part A providers: The final payment for the vaccine and mAb infusion administrations may vary from the published rate based on the institution’s adjusted wage index.
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.