Part B Insider (Multispecialty) Coding Alert

Physician Notes:

Register the Latest At-Home Vaccination Payment Revisions

Published on Fri Sep 17, 2021

PDF

Understand the policy nuances for at-home vaccine administration.

The feds aim to boost COVID-19 vaccination rates as the delta variant surges while making it easier to vaccinate beneficiaries in their homes.

Refresher: Back in June, the Centers for Medicare & Medicaid Services (CMS) offered providers a major financial incentive for administering at-home COVID-19 vaccinations to beneficiaries.

“Medicare is incentivizing providers and will pay an additional $35 per dose for COVID-19 vaccine administration in a beneficiary’s home, increasing the total payment amount for at-home vaccination from approximately $40 to approximately $75 per vaccine dose,” explained CMS in a June 9 release. “For a two-dose vaccine, this results in a total payment of approximately $150 for the administration of both doses, or approximately $70 more than the current rate.”

However, the policy change wasn’t without a few caveats. For example, the add-on applied to only one patient in the home, meaning other residents receiving vaccinations were not paid at the higher rate. Plus, COVID shots given in communal areas in congregate living residences such as assisted living facilities, group homes, and apartments/condos would not qualify for the increase.

New policy: “Healthcare providers can now receive additional payments for administering vaccines to multiple residents in one home setting or communal setting of a home,” CMS clarified in an Aug. 24 release. The change allows “vaccine providers to receive the increased payment up to five times when fewer than ten Medicare beneficiaries get the vaccine on the same day in the same home or communal setting,” CMS elaborated.

The new methodology “aims to further boost the administration of COVID-19 vaccination — including second and third doses — in smaller group homes, assisted living facilities, and other group living situations,” CMS said. “This policy will help ensure that at-risk patients in smaller settings have the same opportunities as others to receive the vaccination,” the release noted.

“We are doing everything we can to remove barriers to vaccinations, including ensuring appropriate payment levels for vaccine providers to connect with more people in their communities who are unable to receive the vaccine in a traditional setting,” said CMS Administrator Chiquita Brooks-LaSure in the release. “We’ve seen the difference that vaccinations have in communities, and we are calling on providers to join us as we continue to increase vaccination rates across the country. Today’s actions ensure that everyone has the ability to be vaccinated against COVID-19, including older adults with mobility or transportation challenges and other at-risk individuals.”

Resource: Read CMS’ release on the change at www.cms.gov/newsroom/press-releases/cms-expands-medicare-payments-home-covid-19-vaccinations. Review Medicare COVID vaccination payment details at www.cms.gov/medicare/covid-19/medicare-covid-19-vaccine-shot-payment. Find out how to enroll as a COVID-19 vaccine provider at www.cms.gov/medicare/covid-19/enrollment-administering-covid-19-vaccines.