2023 COVID-19 vaccine reimbursement

For claims with dates of service on or after January 1, 2023, through December 31, 2023, the national payment rate for the administration of COVID-19 vaccines is $41.52 per dose, and the national payment rate for an additional payment when the COVID-19 vaccine is administered in-home (M0201) is $36.85.

CMS has established codes and fees based on the geographically adjusted payment allowances for the COVID-19 vaccine.

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.

COVID-19 vaccines and administrations no longer authorized

The FDA announced vaccines no longer authorized for use in the U.S. Medicare doesn’t pay for the following CPT/HCPCS codes:

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

COVID-19 vaccine fees

*Providers should not bill for the product if they received it for free.

**The federal government is not purchasing these products. Medicare Part B pays for the drug and its administration under the applicable Medicare Part B payment.

Effective October 3, 2023, CPT code 91304 will be paid at the rates assigned on the Average sales price (ASP) fee file.

Effective September 11, 2023, CPT codes 91318-91322 will be paid at the rates assigned on the Average sales price (ASP) fee file.

COVID-19 vaccine administration fees

CMS has identified specific codes for the COVID-19 vaccine administration codes.

Jurisdiction L

Jurisdiction H

References