CMS Pub. 100-04, ch. 18, § 10.2.2.1

Hepatitis B Virus and COVID-19 Vaccines and Their Administration on

Institutional Claims

(Rev. 13547; Issued: 12-18-25; Effective: 01-20-26; Implementation: 01-20-26)

Payment for Vaccines

Payment for these vaccines is as follows:

Facility Type of Bill Payment

Hospitals, other than Indian

Health Service (IHS)

Hospitals, IHS CAHs, and

Critical Access Hospitals

(CAHs)

012x, 013x Reasonable cost

IHS Hospitals 012x, 013x 95% of the AWP

IHS CAHs 012x, 085x 95% of the AWP

CAHs Method I and

Method II

(other than professional

revenue codes)

012x, 085x Reasonable cost

Skilled Nursing Facilities 022x, 023x Reasonable cost

Home Health Agencies 034x Reasonable cost

Hospices 081x, 082x 95% of the AWP

Comprehensive Outpatient

Rehabilitation Facilities

075x 95% of the AWP

Independent Renal Dialysis

Facilities (RDFs)

072x 95% of the AWP

Hospital-based Renal

Dialysis Facilities (RDFs)

072x Reasonable cost

Rural Health Clinics

(RHCs)

71x 95% of the AWP (effective

for dates of service on or

after July 1, 2025) then

subsequently settled through

the cost report.

Federally Qualified Health

Centers (FQHCs)

77x 95% of the AWP (effective

for dates of service on or

after July 1, 2025)

then subsequently settled

through the cost report.

Payment for Vaccine Administration

Payment for the administration of pneumococcal, influenza, hepatitis B and

COVID-19 vaccines is as follows:

Facility Type of Bill Payment

Hospitals, other than IHS

Hospitals, IHS CAHs, and

CAHs

012x, 013x Outpatient Prospective

Payment System (OPPS) for

hospitals subject to OPPS

Reasonable cost for hospitals

not subject to OPPS

IHS Hospitals 012x, 013x MPFS

IHS CAHs 012x, 085x MPFS

CAHs Method I and

Method II (other than

professional revenue codes)

012x, 085x Reasonable cost

CAHs Method II

(Professional Revenue

Codes 096x, 097x, 098x)

085x MPFS

Skilled Nursing Facilities 022x, 023x MPFS

Home Health Agencies 034x OPPS

Hospices 081x, 082x MPFS

Comprehensive Outpatient

Rehabilitation Facilities

075x MPFS

Independent RDFs 072x MPFS

Hospital-based RDFs 072x Reasonable cost

Rural Health Clinics

(RHCs)

71x National Fee Schedule for

Vaccine Administration

(effective for dates of service on

or after July 1, 2025)

Federally Qualified Health

Centers (FQHCs)

77x National Fee Schedule for

Vaccine Administration

(effective for dates of

service on or after July 1,

2025)