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Medicare Covid 19 Vaccine Reimbursement

Medicare Covid 19 Vaccine Reimbursement

Food and Drug Administration (FDA) has authorized a third Covid 19 dose vaccine for immunocompromised people, CMS said it will provide Medicare reimbursement for immunizers. CMS is assuring people with Medicare who qualify for an additional dose that they can receive it with no cost sharing. For COVID-19 vaccines administered on or after March 15, 2021, the national average payment rate for physicians, hospitals, pharmacies and many other immunizers is $40 to administer each dose of a COVID-19 vaccine.

According to acting FDA Commissioner Janet Woodcock, MD, “The country has entered yet another wave of the COVID-19 pandemic, and the FDA is especially cognizant that immunocompromised people are particularly at risk for severe disease.”

Medicare beneficiaries who qualify for the third dose of either the Pfizer-BioNTech or Moderna COVID-19 vaccines will not be subject to any cost sharing requirements, CMS stated in its announcement.

According to CMS, “This is part of President Biden’s commitment that patients have access to the necessary vaccinations to protect themselves from COVID-19.”

Additional Payment for Administering the Vaccine in the Patient’s Home

Effective June 8, 2021, Medicare’s additional payment amount for administering the COVID-19 vaccine in the home for certain Medicare patients is $35 per dose.

$35 amount in addition to the standard administration amount (approximately $40 per dose), for a total payment of approximately $75 for a single-dose vaccine or $150 for both doses of a 2-dose vaccine, when administered in the home. CMS also geographically adjust the additional amount and administration rate based on where person administer the vaccine.

CMS established this $35 payment amount on a preliminary basis to ensure access to COVID-19 vaccines during the PHE. CMS will continue to evaluate the needs of Medicare patients and these policies, and CMS will address them in the future, as needed.

Qualified Locations for Additional In-home payment

Many types of locations can qualify as a Medicare patient’s home for the additional in-home payment amount, such as:

A private residence

Temporary lodging (for example, a hotel or motel, campground, hostel, or homeless shelter)

An apartment in an apartment complex or a unit in an assisted living facility or group home

A Medicare patient’s home that’s made provider-based to a hospital during the COVID-19 PHE

These locations don’t qualify as a home for the additional payment amount:

Communal spaces of a multi-unit living arrangement

Hospitals (except when the Medicare patient’s home has been made provider-based to a hospital during the COVID-10 PHE)

Medicare skilled nursing facilities (SNFs) and Medicaid nursing facilities, regardless of whether they’re the patient’s permanent residence

Assisted living facilities participating in the CDC’s Pharmacy Partnership for Long-Term Care Program when their residents are vaccinated through this program

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.

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