Big news from Medicare on vaccination reimbursement

NCPA June 9, 2021

Medicare has added an additional payment of $35 for administering the COVID-19 vaccine in homes for Medicare patients who have a difficult time leaving their homes or are hard to reach. That means Medicare will pay $35 in addition to the standard administration amount (approximately $40 per dose), for a total payment of approximately $75 for a single-dose vaccine or $150 for both doses of a two-dose vaccine when administered in the home. CMS will geographically adjust the additional amount and administration rate based on where the vaccine is administered. This is a key announcement for independent pharmacies because it’s mostly independents who are visiting homes. Since the beginning of the pandemic, NCPA has pushed for pharmacists who travel from their pharmacy to meet patient needs be compensated accordingly. More information regarding the COVID-19 vaccination administration in beneficiaries’ homes can be found here. NCPA will participate in a forum today hosted by CMS for more information regarding eligibility and limitations; we’ll let you know what we find out. At this point, skilled nursing facilities and assisted living facilities are excluded from the additional payment. For the latest news on medical at home and LTC services, NCPA’s LTC Division is your best, most trusted source.

Related: Biden again warns insurers and providers not to charge for vaccines.