On March 15, 2021, the Centers for Medicare & Medicaid Services (CMS) announced it will increase the Medicare payment amount for administrating each dose of the COVID-19 vaccine to approximately $40 per administration (exact rate will depend on type of entity and geographic location). Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is reviewing CMS’s announcement and will communicate any impacts to commercial lines of business once determined.

Key Messages

• The Centers for Medicare & Medicaid Services (CMS), which will cover COVID-19 vaccine administration costs through 2021 for Medicare members, updated the Medicare payment rates for providers and its network to administer the COVID-19 vaccine to $38.17. 
• Blue Cross and Blue Shield of North Carolina (Blue Cross NC) will follow CMS guidance for determining payment rates to administer COVID-19 vaccines for commercial members. 
• The rate increase will help providers get needed resources to support vaccine distribution and is applicable for commercial members with claims service dates beginning on April 15, 2021, throughout the public health emergency (PHE).
• Once the PHE is over, the payment rate for COVID-19 vaccine administration will return to the previously allowed amount, as outlined below:
  • For a single-dose vaccine or for the final dose in a series, the payment was $28.39. 
  • For a COVID-19 vaccine requiring a series of two or more doses, the payment rate was $16.94 for the initial dose(s) in the series and $28.39 for the final dose in the series.
• Up-to-date information, preventive tips and resources for our members can be found on our dedicated coronavirus page.

Supporting Points for Lines of Business

Medicare and Medicare Advantage

• In addition to covering the cost of the vaccine during the public health emergency, the federal government will pay for vaccine administration costs for Medicare Advantage members throughout 2021. 

Commercial

• For members of non-grandfathered individual under 65 plans, small and large group (fully-insured and self-funded) plans, transitional plans and student health plans, the federal government will pay for the cost of the vaccine. Blue Cross NC and Administrative Services Only (ASO) groups will cover vaccine administration fees during the public health emergency.  
• For customers on a grandfathered group plan, vaccines will be available at no member cost-share. Blue Cross NC and Administrative Services Only (ASO) groups will cover vaccine administration fees during the public health emergency. For grandfathered plans, providers should submit claims to Blue Cross NC. 
• Blue Cross NC and ASO groups will cover vaccine administration fees for out-of-network (OON) providers during the public health emergency. Current federal rules prohibit any provider from balance billing patients for the COVID-19 vaccine.

State Health Plan (SHP)

• The federal government will pay for the cost of the vaccine and the State Health Plan (SHP) will cover vaccine administration fees during the public health emergency.  
• Providers who signed up for the SHP Clear Pricing Project (CPP) will be reimbursed $64 (160% of the CMS rate of $40) to administer the COVID-19 vaccine.

Federal Employee Program (FEP)

• All federal employee health benefit carriers are required to cover the vaccine without any member cost-sharing for FDA-approved vaccines. The FEP Operations Center is working with the FEP Director’s Office on implementation.