This article will assist you with proper billing relating to COVID-19 vaccine and monoclonal antibody infusion. Beneficiary coinsurance and deductible are waived.
To bill single claims for COVID-19 vaccines and monoclonal antibodies, follow the instructions below.
For roster billing and centralized billing reference the Medicare billing for COVID-19 vaccine shot administration page.
Effective for dates of services on and after January 1, 2022, COVID-19 vaccines and mAbs provided to patients enrolled in a Medicare Advantage plan are to be billed to the Medicare Advantage plan.
When COVID-19 vaccine and monoclonal antibody doses are provided by the government free of charge, only bill for the administration. Don't include the vaccine or infusion drug codes on the claim when the vaccines or infusion drugs are free.
Note: If your software requires you to submit the vaccine or infusion drug codes with the administrations, submit the billed amount as $0.01.
Medicare Part B pays for the drug and its administration under the applicable Medicare Part B payment policy.
Effective October 3, 2023, the federal government is not purchasing the products for CPT code 91304.
Effective September 11, 2023, the federal government is not purchasing the products for CPT codes 91318-91322.
Code |
Descriptor |
Labeler name |
Vaccine/Procedure name |
Effective date |
90480 |
Admn Sarscov2 Vacc 1 dose |
N/A |
Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) COVID-19 vaccine, single dose |
09/11/2023 |
M0201* |
COVID-19 vaccine home admin |
Home vaccine admin |
COVID-19 vaccine administration inside a patient’s home; reported only once per individual home per date of service when only COVID-19 vaccine administration is performed at the patient’s home |
06/08/2021 |
91304 |
Sarscov2 vac 5MCG/0.5ML IM |
Novavax |
Novavax COVID-19 (aged 12 years and older) vaccine, adjuvanted |
07/13/2022 |
91318 |
Sarscov2 vac 3 MCG TRS-SUC |
Pfizer |
Pfizer-BioNTech COVID-19 vaccine 2023-2024 formula (yellow cap) |
09/11/2023 |
91319 |
Sarscv2 vac 10MCG TRS-SUC IM |
Pfizer |
Pfizer-BioNTech COVID-19 vaccine 2023-2024 formula (blue cap) |
09/11/2023 |
91320 |
Sarscv2 vac 30MCG TRS-SUC IM |
Pfizer |
COMIRNATY (COVID-19 vaccine, mRNA) 2023-2024 vormula |
09/11/2023 |
91321 |
Sarscov2 vac 25 MCG/.25ML IM |
Moderna |
Moderna COVID-19 vaccine 2023-2024 formula |
09/11/2023 |
91322 |
Sarscov2 vac 50 MCG/0.ML IM |
Moderna |
SPIKEVAX 2023-2024 formula |
09/11/2023 |
For information on dosing intervals, refer to the CDC article Vaccine and immunizations.
*HCPCS M0201 is billable only on the following TOBs: 13X, 34X, 72X, 75X, 81X, 82X, and 85X. For additional billing information on M0201, review the following CMS resources:
The FDA announced vaccines no longer authorized for use in the U.S. Medicare doesn’t pay for the following CPT/HCPCS codes:
Effective for dates of service on and after June 1, 2023:
Janssen: 0031A, 0034A, and 91303
Effective for dates of service on and after April 18, 2023:
Moderna: 0011A, 0012A, 0013A, 0064A, 0091A, 0092A, 0093A, 0094A, 0111A, 0112A, 0113A, 91301, 91306, 91309, and 91311
Pfizer: 0001A, 0002A, 0003A, 0004A, 0051A, 0052A, 0053A, 0054A, 0071A, 0072A, 0073A, 0074A, 0081A, 0082A, 0083A, 91300, 91305, 91307, and 91308
Effective for dates of service on and after September 12, 2023: Moderna: 0134A, 0141A, 0142A, 0144A, 91313, 91314, and 91316,
Pfizer: 0121A, 0124A, 0151A, 0154A, 0164A, 0171A, 0172A, 0173A, 0174A, 91312, 91315, and 91317
Effective for dates of service on and after October 3, 2023:
Novavax: 0041A, 0042A and 0044A
For payment allowances and locality-adjusted payment amounts for administration of these COVID-19 vaccines, refer to the CMS vaccine pricing - COVID-19 vaccines and monoclonal antibodies
When the COVID-19 vaccine is provided by the government without charge, only bill for the vaccine administration.
Note: If your software requires you to submit the vaccine with the administration, submit the billed amount as $0.01.
Claim should include the proper billing of the ICD-10 diagnosis code, Z23, in item 21:
Report the proper date of service.
Report the proper place of service.
Use the appropriate administration CPT or HCPCs code.
The diagnosis pointer should be used to indicate the primary diagnosis on the claim form.
Report the charge amount for each line item.
Code |
Description |
Labeler name |
Vaccine/Procedure name |
Effective date |
Q0249*/** |
Tocilizumab for COVID-19 |
Genentech |
Injection, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older) with COVID-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) only, 1 mg |
06/24/2021 |
M0249** |
Adm tocilizu COVID-19 1st |
Genentech |
Intravenous infusion, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older) with COVID-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) only, includes infusion and post administration monitoring, first dose |
06/24/2021 |
M0250** |
Adm tocilizu COVID-19 2nd |
Genentech |
Intravenous infusion, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older) with COVID-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) only, includes infusion and post administration monitoring, second dose |
06/24/2021 |
Q0224* |
Inj, pemivibart, 4500 mg |
Invivyd |
Injection, pemivibart, for the pre-exposure prophylaxis only, for certain adults and adolescents (12 years of age and older weighing at least 40 kg) with no known SARS-CoV-2 exposure, and who either have moderate-to-severe immune compromise due to a medical condition or receipt of immunosuppressive medications or treatments, and are unlikely to mount an adequate immune response to COVID-19 vaccination, 4500 mg |
03/22/2024 |
M0224 |
Pemivibart infusion |
Invivyd |
Intravenous infusion, pemivibart, for the pre-exposure prophylaxis only, for certain adults and adolescents (12 years of age and older weighing at least 40 kg) with no known SARS-CoV-2 exposure, who either have moderate-to-severe immune compromise due to a medical condition or receipt of immunosuppressive medications or treatments, includes infusion and post administration monitoring |
03/22/2024 |
** HCPCS Q0249, M0249 and M0250 are billable on TOB 12X (inpatient hospital only).
The following mAbs are currently not authorized under the emergency use authorization (EUA) until further notice by the FDA:
Effective January 24, 2022:
REGEN-COV (casirivimab and imdevimab, administered together):
Q0240, M0240,and M0241
Q0243, M0243, Q0244 and M0244
Bamlanivimab and etesevimab, administered together:
Q0245, M0245, and M0246
Effective April 5, 2022:
Sotrovimab codes Q0247, M0247, and M0248
Effective November 30, 2022:
Bebtelovimab codes: Q0222, M0222, and M0223
Effective January 26, 2023:
EVUSHELD codes: Q0220, Q0221, M0220, and M0221
For more information on mAbs, refer to the CMS COVID-19 vaccines and monoclonal antibodies.
When mAb infusion is provided by the government without charge, only bill for the vaccine administration.
Note: If your software requires you to submit the vaccine with the administration, submit the billed amount as $0.01.
Claim should include the proper billing of the ICD-10 in item 21:
Use appropriate diagnosis coded to highest level of specificity:
U071 - use as appropriate.
Report the proper date of service.
Report the proper place of service.
Use the appropriate administration CPT or HCPCs code
*Don't bill for the product if you received it for free.
The diagnosis pointer should be used to indicate the primary diagnosis on the claim form.
Report the charge amount for each line item.
(This product is currently not authorized)
On February 24, 2022, the FDA revised the EUA for tixagevimab co-packaged with cilgavimab (EVUSHELD) to change the initial dose for the authorized use as pre-exposure prophylaxis of COVID-19 in certain adults and pediatric patients.
On June 29, 2022, the FDA authorized revisions to EVUSHELD (tixagevimab co-packaged with cilgavimab) dosing to recommend repeat dosing six months with a dose of 300 mg of tixagevimab and 300 mg cilgavimab if patients need ongoing protection.
The HCPCS code Q0221 describing the dose of 300 mg of tixagevimab and 300 mg of cilgavimab and the HCPCS codes describing the service to administer EVUSHELD in healthcare settings or in the home (M0220 and M0221, respectively) can be billed for the repeat dosing every six months for patients that need ongoing protection.
For more information about dosage, dosing interval, and administration, review the Fact Sheet for Health care providers: EUA for EVUSHELD (tixagevimab co-packaged with cilgavimab) (ZIP).
Tixagevimab co-packaged with cilgavimab is administered as 2 separate consecutive intramuscular injection.
M0220 and M0221 can be billed for either EVUSHELD dose Q0220 or Q0221.
(This product is currently not authorized)
Eli Lilly started commercial distribution of Q0222 on August 15, 2022. For dates of service on or after August 15, 2022, claims for commercially acquired treatments may be allowed at the new payment rate of $2,394.00. You may have supplies of both the United States Government (USG)-procured and commercially-procured product. Providers should only bill above a nominal amount for the commercially-procured product. You can identify the commercially-procured vials by the batch number D534422 and other batch numbers will be issued. Review the batch number prior to claim submission to determine if the product was USG procured or commercially-procured and ensure appropriate billing.
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