COVID-19 Vaccine and Administration Codes, Payment Allowances & Effective Dates
The COVID-19 Vaccine is here and is ready to be administered. As providers the next big step is to procure the vaccine and administer it. Likewise, it is important to know that Medicare will cover and pay for the administration of the vaccine, when furnished consistent with the Emergency Use Authorization (EUA). The payment and HCPCS Level I CPT code structure for specific COVID-19 vaccine is provided below.
IMPORTANT NOTE: Only bill for the vaccine administration codes when you submit claims to Medicare. Do Not include the vaccine product codes when vaccines are free.
| PFIZER | |||||
| Code | CPT Short Descriptor | Vaccine/Procedure Name | Payment Allowance (DOS on or after 03/15/2021) | Payment Allowance (DOS through 03/14/2021) | Effective Date |
| 91300 | SARSCOV2 VAC 30MCG/0.3ML IM | Pfizer-Biontech Covid-19 Vaccine | $0.010* | $0.010* | 12/11/2020 |
| 0001A | ADM SARSCOV2 30MCG/0.3ML 1ST | Pfizer-Biontech Covid-19 Vaccine Administration – First Dose | $40.000** | $16.940** | 12/11/2020 |
| 0002A | ADM SARSCOV2 30MCG/0.3ML 2ND | Pfizer-Biontech Covid-19 Vaccine Administration – Second Dose | $40.000** | $28.390** | 12/11/2020 |
| MODERNA | |||||
| Code | CPT Short Descriptor | Vaccine/Procedure Name | Payment Allowance (DOS on or after 03/15/2021) | Payment Allowance (DOS through 03/14/2021) | Effective Date |
| 91301 | SARSCOV2 VAC 100MCG/0.5ML IM | Moderna Covid-19 Vaccine | $0.010* | $0.010* | 12/18/2020 |
| 0011A | ADM SARSCOV2 30MCG/0.3ML 1ST | Moderna Covid-19 Vaccine Administration – First Dose | $40.000** | $16.940** | 12/18/2020 |
| 0012A | ADM SARSCOV2 100MCG/0.5ML2ND | Moderna Covid-19 Vaccine Administration – Second Dose | $40.000** | $28.390** | 12/18/2020 |
| ASTRAZENECA | |||||
| Code | CPT Short Descriptor | Vaccine/Procedure Name | Payment Allowance (DOS on or after 03/15/2021) | Payment Allowance (DOS through 03/14/2021) | Effective Date |
| 91302 | SARSCOV2 VAC 5X10^10VP/.5MLIM | AstraZeneca Covid-19 Vaccine | $0.010* | $0.010* | TBD |
| 0021A | ADM SARSCOV2 5X10^10VP/.5ML 1 | AstraZeneca Covid-19 Vaccine Administration – First Dose | $40.000** | $16.940** | TBD |
| 0022A | ADM SARSCOV2 5X10^10VP/.5ML 2 | AstraZeneca Covid-19 Vaccine Administration – Second Dose | $40.000** | $28.390** | TBD |
| JANSSEN | |||||
| Code | CPT Short Descriptor | Vaccine/Procedure Name | Payment Allowance (DOS on or after 03/15/2021) | Payment Allowance (DOS through 03/14/2021) | Effective Date |
| 91303 | SARSCOV2 VAC AD26 .5ML IM | Janssen Covid-19 Vaccine*** | $0.010* | $0.010* | 02/27/2021 |
| 0031A | ADM SARSCOV2 VAC AD26 .5ML | Janssen Covid-19 Vaccine Administration*** | $40.000** | $28.390** | 02/27/2021 |
* CMS will update the payment allowance at a later date as providers will not incur cost initially. Providers should not bill for the product if they received it for free.
** These rates will also be geographically adjusted for many providers.
*** Johnson & Johnson COVID-19 Vaccine
Additional Resources
- CMS – COVID-19 Vaccines and Monoclonal Antibodies
- AAPC – Code COVID-19 Vaccines With Confidence
- Novitas Solutions – Provider specialty: COVID-19 vaccine and monoclonal antibodies
- Novitas Solutions – 2021 COVID-19 vaccine reimbursement