CMS has established new codes and fees based on the geographically adjusted payment allowances for the COVID-19 vaccine. The national administration rate for a two-dose vaccine is $16.94 for the first dose and $28.39 for the second dose. These rates will also be geographically adjusted for many providers. For providers and suppliers with payments that are geographically adjusted by the methodology used by the Medicare Physician Fee Schedule (MPFS), the geographically adjusted payment rates for COVID-19 vaccine administration are listed below. Certain settings utilize other payment methodologies, such as payment based on reasonable costs.
Use the chart below to determine how your facility is reimbursed.
* View the 2021 COVID-19 vaccine reimbursement
Facility |
Type of Bill |
Payment |
Hospitals, other than Indian health services (IHS) hospitals and critical access hospitals (CAHs) |
012x, 013x |
Outpatient prospective payment system (OPPS) for hospitals subject to OPPS Reasonable cost for hospitals not subject to OPPS |
IHS hospitals |
012x, 013x, 083x |
MPFS |
IHS CAHs |
085x |
MPFS |
CAHs method I and II |
085x |
Reasonable cost |
Skilled nursing facilities |
022x, 023x |
MPFS |
Comprehensive outpatient rehabilitation facility |
075x |
MPFS |
Independent renal dialysis facilities (RDFs) |
072x |
MPFS |
Hospital-based RDFs |
072x |
Reasonable cost |
Initially, CMS anticipates that providers will not incur a cost for the product. CMS will update the payment allowance at a later date.
*Providers should not bill for the product if they received it for free.
Code |
Vaccine/Procedure name |
Payment allowance |
91300 |
Pfizer-Biontech COVID-19 vaccine |
$0.010* |
91301 |
Moderna COVID-19 vaccine |
$0.010* |
CMS has identified specific codes for the COVID-19 vaccine administration codes.
Code |
Vaccine/Procedure name |
0001A |
Pfizer-Biontech COVID-19 vaccine administration – first dose |
0002A |
Pfizer-Biontech COVID-19 vaccine administration – second dose |
00011A |
Moderna COVID-19 vaccine administration – first dose |
00012A |
Moderna COVID-19 vaccine administration – second dose |
Locality-adjusted payment amounts for administration of COVID-19 vaccines.
Area |
State |
Locality |
Administration reimbursement first dose 0001A or 0011A |
Administration reimbursement second dose 0002A or 0012A |
Jurisdiction L |
Delaware |
Entire state (01) |
$17.19 |
$28.81 |
DC Metro |
DC + MD/VA suburbs (01) |
$19.47 |
$32.63 |
Maryland |
Baltimore/surr. cntys (01) |
$18.14 |
$30.40 |
Rest of Maryland (99) |
$17.37 |
$29.11 |
New Jersey |
Northern New Jersey (01) |
$19.01 |
$31.86 |
Rest of New Jersey (99) |
$18.36 |
$30.78 |
Pennsylvania |
Metropolitan Philadelphia (01) |
$17.96 |
$30.09 |
Rest of Pennsylvania (99) |
$16.34 |
$27.38 |
Jurisdiction H |
Arkansas |
Entire state (13) |
$15.42 |
$25.85 |
Colorado |
Entire state (01) |
$17.21 |
$28.84 |
Louisiana |
New Orleans (01) |
$16.62 |
$27.85 |
Rest of Louisiana (99) |
$15.92 |
$26.68 |
Mississippi |
Entire state (00) |
$15.40 |
$25.80 |
New Mexico |
Entire state (05) |
$16.17 |
$27.10 |
Oklahoma |
Entire state (00) |
$15.82 |
$26.52 |
Texas |
Austin (31) |
$17.16 |
$28.76 |
Beaumont (20) |
$16.20 |
$27.14 |
Brazoria (09) |
$17.09 |
$28.64 |
Dallas (11) |
$17.11 |
$28.68 |
Fort Worth (28) |
$16.78 |
$28.13 |
Galveston (15) |
$17.18 |
$28.78 |
Houston (18) |
$17.28 |
$28.96 |
Rest of Texas (99) |
$16.31 |
$27.34 |
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