The FDA recently amended the emergency use authorizations for both mRNA vaccines from Pfizer-BioNTech and Moderna to allow for the use of an additional dose in certain immunocompromised individuals, specifically solid organ transplants recipients or those who are diagnosed with conditions considered to have an equivalent level has recommended an additional dose of an mRNA vaccine for moderately to severely immunocompromised individuals previously vaccinated with mRNA vaccines. Mixing and matching between the two mRNA vaccines is acceptable if the primary vaccine series a patient received is not available. It should be noted that these recommended additional doses are not considered “booster doses.” At this time, the EUA for the Janssen COVID-19 vaccine has not been amended for an additional dose and there is no recommendation for an additional dose in individuals previously vaccinated with the Janssen vaccine.
Further, CMS has announced that people with Medicare who qualify for an additional dose can receive it with no cost sharing. Medicare will pay $40 for administering an additional dose of COVID-19 vaccines consistent with the modified FDA, the same amount paid for other doses of the COVID-19 vaccine administered on or after March 15, 2021. NCPA will share additional information and guidance about billing and coding for the additional dose of the COVID-19 vaccine for immunocompromised patients as it becomes available. For additional vaccine billing and reimbursement guidance, check out this NCPA resource.