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Has CMS increased the amount it will pay providers for COVID-19 vaccines administered to patients in their homes?

Yes. On June 9, 2021, CMS released the MLN Connects Special Edition bulletin linked below, advising that beginning June 8, 2021, CMS will now reimburse providers an additional add-on payment of $35.00 for COVID-19 vaccinations administered to beneficiaries in their homes. The add-on payment of $35.00 will be made in addition to the base COVID-19 vaccine administration payment of $40.00, raising the total provider reimbursement to approximately $75.00 when these services are provided to patients in their homes.

To facilitate this add-on payment, CMS has established a new HCPCS code, M0201, to report when COVID-19 vaccines are administered to patients in their homes. We have provided the full long description for HCPCS code M0201 below for your convenience. As a reminder, HCPCS M0201 is reported in addition to the existing product-specific COVID-19 vaccine administration codes (e.g. 0001A, 0002A, 0011A, 0012A, 0031A) when the vaccine is administered in the beneficiary’s home.

M0201: 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

On their COVID-19 Vaccine Shot Payment website, CMS states providers will be eligible for the additional home administration add-on payment when any of these patient specific situations apply:

  • “The patient has difficulty leaving the home to get the vaccine, which could mean any of these:
    • They have a condition, due to an illness or injury, that restricts their ability to leave home without a supportive device or help from a paid or unpaid caregiver
    • They have a condition that makes them more susceptible to contracting a pandemic disease like COVID-19
    • They are generally unable to leave the home, and if they do leave home it requires a considerable and taxing effort
  • The patient is hard-to-reach because they have a disability or face clinical, socioeconomic, or geographical barriers to getting a COVID-19 vaccine in settings other than their home. These patients face challenges that significantly reduce their ability to get vaccinated outside the home, such as challenges with transportation, communication, or caregiving”

CMS states that while providers are not required to certify that the patient is “homebound” (as defined by federal statute), the individual medical record must demonstrate that the patient faces barriers to receiving the COVID-19 vaccine outside of the home.

Additionally, CMS states the add-on payment will be made only in instances where the sole purpose of the home visit is to administer a COVID-19 vaccine. If additional services are rendered to patients within their homes on the same date of service, providers will receive only the base payment amount of $40.00 for the COVID-19 vaccine administration.

CMS also clarifies that HCPCS code M0201 should only be billed once per each home visit. Per the CMS Medicare Billing for COVID-19 Vaccine Shot Administration website:

  • “You should bill for the additional payment amount only once per home per date of service. If you administer the COVID-19 vaccine to more than 1 Medicare patient in a single home on the same day, you should:
    • Bill the HCPCS Level II code (M0201) only 1 time for the additional payment rate
    • Bill for each dose administered using the appropriate CPT code for the product and dose-specific COVID-19 vaccine administration”

It is important to note, CMS has not yet released a corrected Addendum B file that includes new HCPCS code M0201. Therefore, there may be a delay in MACs implementing this new code and its associated add-on payment rate. We recommend providers track claims for COVID-19 home vaccination services closely over the coming weeks. We will provide updates if and when they are released by CMS.

CMS MLN Connects Special Edition, Wednesday, June 9, 2021, “Biden Administration Continues Efforts to Increase Vaccinations by Bolstering Payments for At-Home COVID-19 Vaccinations for Medicare Beneficiaries”:

https://www.cms.gov/outreach-and-educationoutreachffsprovpartprogprovider-partnership-email-archive/2021-06-09-mlnc-se

CMS “Medicare Payment for COVID-19 Vaccination Administration in the Home” resource document:
https://www.cms.gov/files/document/vaccine-home.pdf

CMS “Medicare Billing for COVID-19 Vaccine Shot Administration” homepage:
https://www.cms.gov/medicare/covid-19/medicare-billing-covid-19-vaccine-shot-administration

CMS “COVID-19 Vaccines and Monoclonal Antibodies” homepage:
https://www.cms.gov/medicare/medicare-part-b-drug-average-sales-price/covid-19-vaccines-and-monoclonal-antibodies

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