The Centers for Medicare and Medicaid Services (CMS) and the Washington Health Care Authority separately announced increases to the allowed amounts paid to providers for administration of COVID-19 vaccines. Effective for vaccines administered on or after March 15, 2021, CMS increased the allowable amount for Medicare patients to $40 per dose, or $80 total for administration involving two doses. The previous payment was around $28 for one dose and about $45 for two doses. More information on COVID-19 Vaccine administration codes and payment is here. The payment increases are welcome as the previous payment amounts did not reflect the costs of administration and billing for the services.
The Washington Health Care Authority announced that it will also increase its allowed amounts for COVID-19 vaccine administration for Medicaid (fee-for-service and managed care) occurring on or after April 1, 2021, to match the new Medicare rates. Vaccines administered prior to April 1 will be paid at the prior, lower rates.
While the increases do not automatically apply to insurers other than Medicare or Medicaid, many insurers base their allowed amounts on Medicare allowed amounts. WSHA has notified commercial health plans in our state about the increases and recommends providers and hospitals that administer the vaccine contact insurers directly for more information.
WSHA has also been working with state agencies regarding direct payment for situations such as mass vaccination sites where it is difficult or impossible to obtain insurance billing information from vaccine recipients without causing significant delays or unnecessary exposure. These will need to be arranged through the local health jurisdiction as part of its mass vaccination plan. More information is here. (Andrew Busz, AndrewB@wsha.org)