Effective June 8, 2021, Medicaid will pay an extra $35, in addition to the standard administration payment (approximately $40 per COVID-19 vaccine dose), for a total payment of approximately $75 for a vaccine dose administered in a patient's home.
The additional payment applies when the COVID-19 vaccine is administered in Medicaid patients’ homes, under the following conditions:
- Beneficiary has disability, illness, or injury, which makes travel difficult.
- Beneficiary faces clinical, socioeconomic or geographical barriers to getting a COVID-19 vaccine in settings other than their home.
- Beneficiary has a condition that makes them more susceptible to contracting COVID-19.
The following locations do NOT qualify as a home for the additional payment amount, regardless of whether it is the patient’s permanent residence:
- Hospitals
- Medicaid skilled nursing facilities (SNFs)
Medicaid will only pay the additional payment for administering the COVID-19 vaccine in the home if the sole purpose of the visit is to administer a COVID-19 vaccine.
Medicaid will follow all other applicable rules as set by CMS and in parity with Medicare rules for payment.
Place of service code on the claims must be 12 HOME.
M0201 MUST be billed with another COVID-19 vaccine administration code recognized and paid for by Medicaid (0001A, 0002A, 0003A, 0011A, 0012A, 0013A, 0031A).
CONTACT:
NCTRACKS Contact Center: 800-688-6696