Effective October 1, 2023, COVID-19 vaccine administration reimbursement will reflect current pricing rules and no longer follow the mandated $40 reimbursement fee.

Providers should continue to:

• Use the established procedure codes for administration of the COVID-19 vaccines
• Follow immunization schedule guidance — recommended by the Centers for Disease Control and Prevention (CDC) — for administration of the COVID-19 vaccines

The CDC will issue the Morbidity and Mortality Weekly Report for COVID-19 guidance along with influenza vaccine guidance in the fall of 2023.

Employer Groups

Employer Groups that did NOT have general out-of-network (OON) vaccine coverage prior to the Public Health Emergency (PHE) will no longer cover OON COVID-19 vaccines effective June 1, 2023.

Groups that did have OON vaccine coverage prior to PHE will retain OON coverage for the COVID-19 vaccine after June 1, 2023.

Medicare Advantage (MA) – No Pricing Changes

MA plans will continue to follow Centers for Medicare and Medicaid Services (CMS) guidance for vaccine pricing through 2023, with no pricing changes anticipated until 2024.