Medicare Billing for Administration of the COVID-19 Vaccine

COVID-19; CMS; Skilled Nursing Facilities (SNF)

During the public health emergency (PHE), the Centers for Medicare & Medicaid Services (CMS) utilized enforcement discretion to allow entities, such as long term care pharmacies, that provide vaccinations to SNF residents to directly bill and receive payment for the administration of COVID-19, influenza, and pneumococcal vaccines. The enforcement discretion stated: 
“CMS will exercise such discretion (1) during the emergency period defined in paragraph (1)(B) of section 1135(g) of the Social Security Act (42 U.S.C. § 1320b-5(g)) and ending on the last day of the calendar quarter in which the last day of such emergency period occurs; or (2) so long as CMS determines that there is a public health need for mass COVID-19 vaccinations in congregate care settings—whichever is later.”  
CMS did not extend this enforcement discretion, meaning that it will end on June 30, 2023. 
Providers are encouraged to review CMS Billing Guidance: Medicare Billing for COVID-19 Vaccine Shot Administration for detailed information on billing to start preparing now for this change in billing.