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2021 – Administration Codes Fee Schedule – COVID-19 Vaccines and Monoclonal Antibodies

Kentucky

Admin Code	Description	Effective Date	Fee Schedule
0001A	Pfizer-Biontech Covid-19 Vaccine Administration – First Dose	Service rendered on 01/01/2021 - 03/14/2021	$15.62
0001A	Pfizer-Biontech Covid-19 Vaccine Administration – First Dose	Service rendered on and after 03/15/2021	$36.67
0002A	Pfizer-Biontech Covid-19 Vaccine Administration – Second Dose	Service rendered on 01/01/2021 - 03/14/2021	$25.81
0002A	Pfizer-Biontech Covid-19 Vaccine Administration – Second Dose	Service rendered on and after 03/15/2021	$36.67
0011A	Moderna Covid-19 Vaccine Administration – First Dose	Service rendered on 01/01/2021 - 03/14/2021	$15.62
0011A	Moderna Covid-19 Vaccine Administration – First Dose	Service rendered on and after 03/15/2021	$36.67
0012A	Moderna Covid-19 Vaccine Administration – Second Dose	Service rendered on 01/01/2021 - 03/14/2021	$25.81
0012A	Moderna Covid-19 Vaccine Administration – Second Dose	Service rendered on and after 03/15/2021	$36.67
0031A	Janssen Covid-19 Vaccine Administration	Service rendered on February 02/04/2021 – March 03/14/2021	$28.39
0031A	Janssen Covid-19 Vaccine Administration	Service rendered on and after 03/15/2021	$36.67
M0239	Intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoring	Service rendered on and after 01/01/2021	$272.59
M0243	Intravenous infusion, casirivimab and imdevimab includes infusion and post administration monitoring	Service rendered on and after 01/01/2021 – 05/05/2021	$272.59
M0243	Intravenous infusion, casirivimab and imdevimab includes infusion and post administration monitoring	Service rendered on and after 05/06/2021	$394.34
M0244	Intravenous infusion, casirivimab and imdevimab includes infusion and post administration monitoring in the home or residence; this includes a beneficiary's home that has been made provider-based to the hospital during the covid-19 public health emergency	Services rendered on and after 05/06/2021	$657.74
M0245	Intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring	Service rendered on and after 02/09/2021	$309.60
M0245	Intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring	Services rendered on and after 05/06/2021	$394.34
M0246	Intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring in the home or residence; this includes a beneficiary's home that has been made provider-based to the hospital during the covid-19 public health emergency	Services rendered on and after 05/06/2021	$657.74

Ohio

Admin Code	Description	Effective Date	Fee Schedule
0001A	Pfizer-Biontech Covid-19 Vaccine Administration – First Dose	Service rendered on 01/01/2021 - 03/14/2021	$16.19
0001A	Pfizer-Biontech Covid-19 Vaccine Administration – First Dose	Service rendered on and after 03/15/2021	$37.98
0002A	Pfizer-Biontech Covid-19 Vaccine Administration – Second Dose	Service rendered on 01/01/2021 - 03/14/2021	$26.78
0002A	Pfizer-Biontech Covid-19 Vaccine Administration – Second Dose	Service rendered on and after 03/15/2021	$37.98
0011A	Moderna Covid-19 Vaccine Administration – First Dose	Service rendered on 01/01/2021 - 03/14/2021	$16.19
0011A	Moderna Covid-19 Vaccine Administration – First Dose	Service rendered on and after 03/15/2021	$37.98
0012A	Moderna Covid-19 Vaccine Administration – Second Dose	Service rendered on 01/01/2021 - 03/14/2021	$26.78
0012A	Moderna Covid-19 Vaccine Administration – Second Dose	Service rendered on and after 03/15/2021	$37.98
0031A	Janssen Covid-19 Vaccine Administration	Service rendered on 01/01/2021 - 03/14/2021	$28.39
0031A	Janssen Covid-19 Vaccine Administration	Service rendered on and after 03/15/2021	$37.98
M0239	Intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoring	Service rendered on and after 01/01/2021	$286.84
M0243	Intravenous infusion, casirivimab and imdevimab includes infusion and post administration monitoring	Service rendered on and after 01/01/2021 – 05/05/2021	$286.43
M0243	Intravenous infusion, casirivimab and imdevimab includes infusion and post administration monitoring	Service rendered on and after 05/06/2021	$414.93
M0244	Intravenous infusion, casirivimab and imdevimab includes infusion and post administration monitoring in the home or residence; this includes a beneficiary's home that has been made provider-based to the hospital during the covid-19 public health emergency.	Services rendered on and after 05/06/2021	$692.15
M0245	Intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring	Service rendered on and after 02/09/2021 – 05 /05/2021	$309.60
M0245	Intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring	Service rendered on and after 05/06/2021	$414.93
M0246	Intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring in the home or residence; this includes a beneficiary's home that has been made provider-based to the hospital during the covid-19 public health emergency.	Services rendered on and after 05/06/2021	$692.15

For complete COVID-19 Vaccines and Monoclonal Antibodies fee schedule information, please refer to the CMS COVID-19 webpage.