Medicare Reimbursement Available for Third Dose of COVID-19 Vaccine

Now that the Food and Drug Administration (FDA) has authorized a third dose of COVID-19 vaccines for immunocompromised people, CMS said it will provide Medicare reimbursement for immunizers.

A CMS announcement made earlier today said that Medicare will continue to pay physicians, hospitals, pharmacies, and many other immunizers the national average payment rate of $40 for each dose of a COVID-19 vaccine given on or after March 15, 2021. This Medicare reimbursement rate will apply to all third doses of the vaccines, the announcement confirmed.

The federal agency also said it will provide more information and guidance in the coming days on medical billing and coding procedures for the additional dose of the vaccines.

FDA amended the emergency use authorizations for the Pfizer-BioNTech and Moderna COVID-19 vaccines yesterday. The amendment gave the green light to providers and other immunizers to give an additional dose of the vaccines to immunocompromised individuals. Specifically, the amendment calls out solid organ transplant recipients or those who are diagnosed with conditions that are considered to have an equivalent level of immunocompromise.

“The country has entered yet another wave of the COVID-19 pandemic, and the FDA is especially cognizant that immunocompromised people are particularly at risk for severe disease,” Acting FDA Commissioner Janet Woodcock, MD, said in the announcement.

FDA intends for the expanded emergency use authorizations to “boost immunity in certain immunocompromised individuals who need extra protection from COVID-19,” Woodcock stated.

“As we’ve previously stated, other individuals who are fully vaccinated are adequately protected and do not need an additional dose of COVID-19 vaccine at this time. The FDA is actively engaged in a science-based, rigorous process with our federal partners to consider whether an additional dose may be needed in the future.”

Medicare beneficiaries who qualify for the third dose of either the Pfizer-BioNTech or Moderna COVID-19 vaccines will not be subject to any cost sharing requirements, CMS stated in its announcement.

“This is part of President Biden’s commitment that patients have access to the necessary vaccinations to protect themselves from COVID-19,” according to CMS.