April 8, 2021
This was originally posted in the MLN Connects Newsletter for Thursday, April 1, 2021.
COVID-19 Vaccine Administration – No Out-of-Pocket Cost to Patients
If you participate in the CDC COVID-19 Vaccination Program, you must:
- Administer the vaccine with no out-of-pocket cost to your patients for the vaccine or administration of the vaccine
- Vaccinate everyone, including the uninsured, regardless of coverage or network status
You also can't:
- Balance bill for COVID-19 vaccinations
- Charge your patients for an office visit or other fee if COVID-19 vaccination is the only medical service given
- Require additional medical or other services during the visit as a condition for getting a COVID-19 vaccination
Report any potential violations of these requirements to the HHS Office of the Inspector General:
- Call 1-800-HHS-TIPS
- Submit an online complaint
Submit claims for administering COVID-19 vaccines to:
- Medicare, if your patient has Medicare Part B coverage or, for 2020 and 2021, Medicare Advantage (Part C)
- Private insurance company, including if your patient only has Medicare Part A coverage with supplemental coverage from a private insurer
- Your state’s Medicaid program for patients with Medicaid and Children’s Health Insurance Program (CHIP) coverage
- Health Resources & Services Administration (HRSA) COVID-19 Uninsured Program, including if your Medicare patient only has Part A coverage with no supplemental coverage