Medicare Compliance & Reimbursement

The verdict on COVID-19 booster shots is in. The feds have determined and authorized that some individuals should receive booster shots to bolster the effects of their original vaccinations.

Update: On Sept. 22, “the U.S. Food and Drug Administration (FDA) amended the emergency use authorization (EUA) for the Pfizer-BioNTech COVID-19 Vaccine to allow for use of a single booster dose, to be administered at least six months after completion of the primary series,” an FDA release said. The following individuals — who completed their first vaccination series at least six months ago — are recommended to receive the booster shot, according to Centers for Disease Control and Prevention (CDC) guidance:

• individuals 65 years of age and older;
• individuals 18 years and up with underlying illnesses and at high risk of severe illness from COVID-19;
• individuals 18 years and up who work in high-risk settings or live in high-risk settings.

Soon after the FDA and CDC updates, the Centers for Medicare & Medicaid Services (CMS) reminded that it would fully cover COVID-19 vaccinations for Medicare beneficiaries, including the booster shots.

“The Biden-Harris Administration has made the safe and effective COVID-19 vaccines accessible and free to people across the country. CMS is ensuring that cost is not a barrier to access, including for boosters,” said CMS Administrator Chiquita Brooks-LaSure in a Sept. 24 release. “CMS will pay Medicare vaccine providers who administer approved COVID-19 boosters, enabling people to access these vaccines at no cost.”

The Medicare payment rates for a single dose of the “COVID-19 vaccines administered on or after March 15, 2021, additional doses of the COVID-19 vaccine administered to immunocompromised individuals on or after August 12, 2021, and booster doses administered to certain populations on or after September 22, 2021” are about $40 for single-dose vaccines and $40 for additional doses and boosters, CMS indicates in its COVID-19 vaccination payment guidance.

Read the FDA authorization at www.fda.gov/news-events/press-announcements/fda-authorizes-booster-dose-pfizer-biontech-covid-19-vaccine-certain-populations. Review CDC guidance at www.cdc.gov/coronavirus/2019-ncov/vaccines/booster-shot.html. Find the CMS release and additional Medicare provider links on vaccination administration at www.cms.gov/newsroom/press-releases/cms-will-pay-covid-19-booster-shots-eligible-consumers-can-receive-no-cost.