COVID-19 Vaccine Pricing for 2026-2027
- By Renee Dustman
- In Billing
- September 14, 2026
- No Comments
National payment allowances for COVID-19 vaccines given during the 2026-2027 season are now available. The Centers for Medicare & Medicaid Services (CMS) released the update on Sept. 1.
Prices for the following COVID-19 vaccines are effective Aug. 27, 2026.
| CPT® | Descriptor | Product | Payment |
| 91304 | Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, recombinant spike protein nanoparticle, saponin-based adjuvant, 5 mcg/0.5 mL dosage, for intramuscular use | Novavax | $232.218 |
| 91319 | Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, 10 mcg/0.3 mL dosage, tris-sucrose formulation, for intramuscular use | Pfizer | $103.330 |
| 91320 | Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, 30 mcg/0.3 mL dosage, tris-sucrose formulation, for intramuscular use | Pfizer | $230.405 |
| 91321 | Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, 25 mcg/0.25 mL dosage, for intramuscular use | Moderna | $172.967 |
| 91322 | Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, 50 mcg/0.5 mL dosage, for intramuscular use | Moderna | $172.967 |
| 91323 | Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, 10 mcg/0.2 mL dosage, for intramuscular use | Moderna | $252.225 |
Vaccine administration fees are unchanged from the previous season. The payment allowance for vaccine administration reported with CPT® 90480 is $44.95.
Medicare Pays More for In-Home Vaccines
As of Jan. 1, 2024, providers who administer vaccines to Medicare patients in their homes may bill an additional fee when the following requirements are met:
- The patient has difficulty leaving their home for a medical reason (e.g., illness, injury, condition) or has another legitimate reason for not being able to leave their home (e.g., lack of transportation).
- The provider documents in the patient’s medical record why the patient cannot leave their home to be vaccinated and this is captured on the claim with appropriate ICD-10-CM coding.
- The additional payment may not be billed for vaccines administered to patients residing in Medicare skilled nursing facilities and Medicaid nursing facilities.
- The additional payment may be billed once per patient per date of service, up to a maximum of five vaccine administration services when fewer than 10 Medicare patients get a vaccine dose on the same day at the same group home.
- When 10 or more Medicare patients receive a vaccination on the same day at the same group living home, only one additional payment may be billed.
- The additional payment for an in-home vaccine does not apply if the purpose of the visit is for another billable service such as an evaluation and management service.
For the additional payment, bill HCPCS Level II code M0201 Administration of pneumococcal, influenza, hepatitis b, and/or covid-19 vaccine inside a patient’s home; reported only once per individual home per date of service when such vaccine administration(s) are performed at the patient’s home.
The payment allowance for M0201 is also unchanged at $39.90.
The complete list of 2026-2027 COVID-19 vaccine pricing is available on the CMS website. A crosswalk is available with the most up to date National Drug Codes for the 2026-2027 season.
The 2026-2027 influenza payment amounts were released in July.
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