CMS Provider COVID-19 Vaccine Guidance

Kathleen Gravelle – CareAllies contributor

CMS has released guidance for providers designed to increase the number of providers prepared to administer the COVID-19 vaccine.  The guidance is also meant to advise Medicare providers to ensure adequate reimbursement for administering the vaccine, while making it clear to private insurers and Medicaid programs their responsibility to cover the vaccine administration at no charge to beneficiaries.  Because the initial supply of COVID-19 vaccines will be federally purchased, the CMS toolkits focus on coverage of vaccine administration. Vaccine doses purchased by the federal government will be provided at no cost.  In addition, providers that participate in the CDC COVID-19 Vaccination Program contractually agree to administer a COVID-19 vaccine regardless of an individual’s ability to pay and regardless of their coverage status, and also may not seek any reimbursement, including through balance billing, from a vaccine recipient.  Providers administering the vaccine to people without health insurance or whose insurance does not provide coverage of the vaccine can request reimbursement for the administration of the COVID-19 vaccine through the Provider Relief Fund.

The links below provide information on:

• How health care providers can enroll in Medicare to bill for administering COVID-19 vaccines when available
• The COVID-19 Vaccine Medicare coding structure
• Medicare reimbursement for COVID-19 vaccine administration
• How health care providers can bill correctly for administering vaccines, including roster and centralized billing

CMS Provider COVID-19 Tool Kit Table of Contents:

• Enrollment for Administering COVID-19 Vaccine Shots
• Coding for COVID-19 Vaccine Shots
• Medicare COVID-19 Vaccine Shot Payment
• Medicare Billing for COVID-19 Vaccine Shot Administration
• SNF: Enforcement Discretion Relating to Certain Pharmacy Billing
• Beneficiary Incentives for COVID-19 Vaccine Shots
• CMS Quality Reporting for COVID-19 Vaccine Shots
• *Updated*Medicare Monoclonal Antibody COVID-19 Infusion