Healthcare providers will play a key role when a COVID-19 vaccine becomes available. CMS has issued a set of toolkits for providers, states and insurers to help in preparation of administering the vaccine when it becomes available. Medicare has provided these resources to help increase the number of providers that can administer the vaccine and ensure ample reimbursement for administration. They have also made it clear to Medicaid and private insurers their responsibility to cover the cost of the vaccine at no charge to the patient.
If you are not a Medicare enrolled provider then you need to enroll as a mass immunizer or other provider type to be able to bill for administering the vaccine. Please review the toolkits to see if your pharmacy needs to update your provider type. The toolkits explain how a pharmacy can enroll and discusses the Medicare coding structure and reimbursement strategy.
Medicare has established administration payment rates for the 2-dose series at $16.94 for the initial dose, and $28.39 for the final dose – incentivizing pharmacies and other providers to make sure the patient comes back for the second dose.
- Read the enrollment section of the toolkit to see if your pharmacy needs to take any current action
- You can enroll as a mass immunizer over the phone – call your MAC-specific enrollment hotline
- CMS will update the toolkits as new information becomes available
- Make sure your pharmacy is prepared and educated on billing and administering the COVID-19 vaccine
- Biosimilar Advancements: Understanding the Latest Updates on Humira® with Cyltezo® and Abrilada™ - October 30, 2023
- $32 Million Kickback Scheme Involving Medicare and TRICARE - October 16, 2023
- Breyna™ – The First FDA Approved Symbicort® Generic With a 0.1 Gram Problem - October 14, 2023