Medicare Raises Payment for Administering COVID-19 Vaccines | Vaccination | JAMA | JAMA Network
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Health Agencies Update
April 27, 2021

Medicare Raises Payment for Administering COVID-19 Vaccines

JAMA. 2021;325(16):1601. doi:10.1001/jama.2021.5882

The Centers for Medicare & Medicaid Services (CMS) recently increased the Medicare payment rate for administering COVID-19 vaccines to approximately $40 per shot.

The rate will be adjusted based on where in the country the vaccine is administered.

Previously, Medicare paid $28.93 for a single-dose vaccine or for the second dose in a series of 2, and $16.94 for the first dose in a series of 2.

Two authorized vaccines in the US, manufactured by Pfizer-BioNTech and Moderna, require 2 injections 3 and 4 weeks apart, respectively. The third authorized vaccine in the US is manufactured by Janssen/Johnson & Johnson and requires only 1 shot.

The increased payments reflect updated information about the vaccine administration costs for different types of providers and suppliers and the additional resources needed to ensure safe and appropriate administration, according to CMS.

Usually, CMS changes Medicare payments for specific services through notice and comment rulemaking, but to save time during the COVID-19 pandemic, the agency bypassed that route before increasing payments for administering the vaccines. However, CMS said it continues to seek information from the public for reviewing and establishing payment rates for vaccine administration, both during the pandemic and on a longer-term basis.

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    1 Comment for this article
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    CPT 99072
    Morton Sherman, MD | Retired Cardiologist
    I serve as the Alternate Member to the RUC (Relative Value Update Committee) from the American College of Cardiology. Following the April, 2020 RUC Meeting, the RUC and CPT responded to recommendations that there be an increase in practice expense fees to cover extraordinary out-patient costs during the public health emergency (PHE). CPT Code 99072 was created and given value by the RUC and its Practice Expense Committee. In the Final Rule, CMS accepted 99072 BUT decided not to pay for these expenses. It might as well have rejected our RUC recommendation. It is my understanding that the COVID vaccination codes valued during the PHE by the RUC have been adjusted by the same values created in 99072. That is reflected in these extra payments.

    The White House has not instructed CMS to give medical practices a bonus. Instead, they followed the RUC recommendations. I urge Federal Legislators and the White House to authorize this extra expense coverage not just for COVID vaccinations but for all encounters during the PHE. Payment for 99072 should be authorized. The previous leadership at CMS/HHS rejected 99072. The current leadership has passed out a piece of hard candy when what we really need is a good meal.
    CONFLICT OF INTEREST: None Reported
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