CMS Releases Updated Rules on COVID-19 Vaccine and Therapeutics Proposed Rule

On October 28, CMS finalized a fourth COVID-19 Interim Final Rule with Comment, which provides coverage and payment details for COVID-19 vaccines and therapeutics. Medicare will cover the cost of COVID-19 vaccines and their administration and will waive out-of-pocket costs for both traditional fee-for-service beneficiaries and beneficiaries enrolled in Medicare Advantage plans. Medicare will pay physicians $28.39 to administer coronavirus vaccines. For vaccines that require two doses, Medicare will pay $16.95 for the first dose and $28.39 for the second dose. These rates will be geographically adjusted.

The rule also requires Medicaid, Children’s Health Insurance Program agencies, and most private health plans to administer the vaccine at no cost to patients during the public health emergency. The Department of Health and Human Services will cover the cost of the vaccine and its administration for any uninsured individuals through the CARES Act Provider Relief Fund. The press release announcing the new rule acknowledges “CMS and the American Medical Association (AMA) are working collaboratively on finalizing a new approach to report use of COVID-19 vaccines, which include separate vaccine-specific codes. Providers and insurance companies will be able to use these to bill for and track vaccinations for the different vaccines that are provided to their enrollees.”

The rules are effective immediately and have a 60-day comment period. CMS released additional information including a fact sheet, COVID-19 vaccine resources, and FAQs on billing for therapeutics.