COVID-19 Vaccines Booster Shots: Codes & Payment

The FDA amended the emergency use authorizations (EUAs) for both the Pfizer BioNTech COVID-19 vaccine and the Moderna COVID-19 vaccine to allow for an additional dose in certain immunocompromised people.

Effective August 12, 2021, CMS will pay $40 to administer additional doses of COVID-19 vaccines consistent with the FDA EUAs using CPT code 0003A for the Pfizer vaccine and CPT code 0013A for the Moderna vaccine. 

What Restrictions Apply?

Medicare only pays the additional amount of $35.00 for administering the COVID-19 vaccine at home if the sole purpose of the visit is to administer a COVID-19 vaccine. Medicare doesn’t pay the additional amount if the physician provides another Medicare service in the same home on the same date. In those situations, Medicare pays for administering the COVID-19 vaccine at the standard amount (approximately $40 per dose).