January 7, 2021
Great news – COVID-19 vaccines are now being distributed!
If you’ll be administering the vaccine, make sure you’re enrolled with CMS so that the vaccine can be swiftly distributed once it’s available for our Medicare Advantage patients.
Here’s what you need to know:
- To receive reimbursement for administering the shot to Medicare patients, you need to be enrolled in Medicare. If you’re already enrolled as a Medicare institutional or non-institutional provider type, you don’t need to take any action to administer and bill the COVID-19 shot. You can review enrollment information to administer the vaccine on the CMS website.
- For the vaccines that require more than one dose, it’s important to tell patients that they need to get both doses of the same vaccine.
- The vaccine is free. Providers can’t charge patients to administer the shot. To administer the free vaccine, healthcare organizations must sign an agreement with the U.S. government. The agreement includes the following:
- All providers must vaccinate individuals with no health coverage, or any type of coverage they have.
- The vaccine is covered whether the provider is in or out of network. No balance billing or cost shares can be billed to the patient.
- Providers will provide patients with emergency use authorization (EUA) fact sheets about the vaccine and vaccination cards.
- You must administer the vaccine in accordance with CDC and Advisory Committee on Immunization Practices (ACIP) requirements and meet storage and record-keeping requirements.
- You must record information about the vaccination into your system within 24 hours and to applicable public health systems within 72 hours.
- Payment for administrating the vaccine to Medicare Advantage patients will be paid by Medicare. Providers will need to submit their claims for administering the COVID-19 vaccine to the CMS Medicare Administrative Contractor (MAC) using product-specific codes for each vaccine approved.
We’ll continue to provide updates from CMS as they become available, but we encourage you to check the CMS website or our FAQ for more information about the vaccine.