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November 18, 2021

Upcoming Changes to CMS Physician Reimbursement Procedures for COVID-19 Vaccine Administration Services to Medicare Advantage Enrollees

Effective January 1, 2022, CMS will change the way physicians bill and get paid for providing COVID-19 vaccine administration services to Medicare Advantage enrollees.  If a participating physician vaccinates a Medicare Advantage patient on or after January 1, 2022, the physician should submit a COVID-19 vaccine administration claim to the patient’s Medicare Advantage plan, because fee-for-service (FFS) Medicare will no longer pay vaccine administration claims.

For any vaccine administration services a physician provides to a Medicare Advantage enrollee through the end of 2021, the physician must submit the Medicare Advantage claim to the Medicare FFS Administrative Contractor.

Because the federal government supplies the vaccine at no cost, a physician cannot bill for the vaccine itself, only for administration—so the claim should include the vaccine administration CPT code only.   New vaccine administration CPT codes are manufacturer- and dose-specific.