As of February 27, 2021, four COVID-19 vaccines have been approved for emergency use and have all been issued CPT codes (please see “Coding Update – 2021” on the PGM Blog for CPT codes and NDC numbers). On March 3, 2010 the Centers for Medicare and Medicaid Services (CMS) released the payment allowances for each vaccine and administration.

  • Vaccine
    • $0.010 per unit
  • First Administration
    • $16.940
  • Second Administration
    • $28.390

For the vaccines that only require one dose, the reimbursement will match that of the second administration – $28.390.  CMS anticipates that providers will likely not incur a cost for the product, initially. If vaccines are state supplied, an ‘SL’ modifier should be appended to the vaccine CPT code. However, it does not need to be appended to the administration code. This indicates that the vaccine was obtained at no cost to the provider and therefore should not be paid or reimbursed. CMS will update the payment allowances at a later date if/when necessary.
Additional reimbursement information can be found here.
During an interview with Fox Business, CEO of Novavax, Stanley C. Erck announced that the Novavax Covid-19 Vaccine will likely be available in the United Kingdom prior to the United States since phase 3 trials are still ongoing in the USA. Mr. Erck also stated that Novavax received $1.6B from the government to help with the development and distribution of the Coronavirus Vaccine and that by “roughly the third quarter of this year,” the manufacturing rate of roughly 150 million doses per month. Once Novavax has been approved in the United States, CPT codes and NDC numbers will be assigned. The Novavax vaccine is two doses given one month apart.

About PGM

Physicians Group Management (PGM) is one of the fastest-growing medical billing companies in the United States.  For over 35 years, PGM has been providing medical billing and practice management services and software to physicians, healthcare facilities, and laboratories.  PGM’s current client base encompasses the full spectrum of medical specialties, including Internal Medicine, Dermatology, Plastic & Reconstructive Surgery, Pathology, EMS & Ambulatory Services, Cardiology, Nephrology, Urology, Pain Management, OB/GYN, Gastroenterology, Independent Laboratory, and many more.  PGM’s medical billing and practice management solutions include:

– A full suite of practice management and medical billing solutions each tailored to the specific needs of your practice

– CCHIT-certified electronic medical record software and services

– Streamlined, customized credentialing services for providers of all sizes

– Practice management software that provides advanced financial and practice analysis tools, specifically designed to give enhanced visibility of operations at the click of a button

Laboratory billing software that offers best-in-class systems to streamline, and manage and track, financial and administrative processes