September 15th, 2021
Categories: CMS Updates, Practice Management

Elderly woman receiving Covid vaccine at home

Date: 09|15|2021   Approx. 2 min. read
Author: Brianna Plencner, CPC, CPMA  Senior Consultant & Manager, Practice Development, HCCI

The Centers for Medicare & Medicaid Services (CMS) announced on August 24th further action to expand payment flexibilities for administering COVID-19 vaccines at home.

Overall, CMS is trying to do the right thing, and I appreciate and am encouraged by their efforts to compensate for the unique cost and logistic considerations for vaccinating home-limited patients. However, there are still barriers prohibiting clinicians from being paid the additional travel HCPCS code if they provide and bill for any other professional service at the time of the vaccine. You cannot bill an Evaluation and Management (E/M) visit and receive the added reimbursement for giving the COVID-19 vaccine at home.

What changed on 08/24/21?

  • CMS recognized communal spaces of a multi-unit or communal living arrangement as an approved “home” site eligible for the additional payment when giving the vaccine.
  • If you’re vaccinating between 2-10 patients in the same “home” or communal living space, CMS updated their policy to allow for the additional payment at home (HCPCS M0201 ) for a maximum of 5 units of vaccine administration services per location.

I’ve still been receiving some questions, so I thought it would be beneficial to create one place where practices can utilize for guidance on billing for the COVID-19 vaccine at home in case booster vaccine efforts are rolled out.

If the sole purpose of the visit is to provide the COVID-19 vaccination at home, report the following 3 codes:

  • The appropriate COVID-19 vaccine code depending on the manufacture and which number dose is given (See CMS graph for vaccine codes)
  • The corresponding code for administration of the vaccine (also included in the CMS graph linked above)
  • HCPCS M0201 (pays approximately $35 as additional reimbursement for administering the vaccine at home. You cannot report this code if billing for any other professional services other than COVID-19 vaccine administration)

For additional information, refer to the following resources: