On October 28, 2020, the Centers for Medicare and Medicaid Services (CMS) announced that the Part B coverage of a COVID-19 vaccine and its administration meets the significant cost threshold. Based on this determination, Medicare payment for COVID-19 vaccinations administered during calendar years 2020 and 2021 to Medicare beneficiaries enrolled in Medicare Advantage plans will be made through the original Medicare Fee-for-Service program, not Medicare Advantage plans. Medicare participating providers or suppliers eligible to bill under Part B for vaccine administration, including those enrolled in Medicare as a mass immunizer or a physician, non-physician practitioner, hospital, clinic, or group practice will need to submit COVID-19 vaccine administration claims to the CMS Medicare Administrative Contractor (MAC) for payment. There is no cost sharing responsibility for Medicare beneficiaries who receive a COVID-19 vaccine.
Please educate applicable administrative staff responsible for billing about this CMS directive. Claims received by Mercy Care for COVID-19 vaccine administration provided to Mercy Care Advantage members with a 2020 or 2021 date of service will be denied by Mercy Care.
Additional Resources:
CMS has released a set of toolkits for providers, states and insurers to help the health care system prepare to swiftly administer the vaccine once available.
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