Medicaid to Increase Payment Per COVID-19 Vaccine Dose


Starting April 1, Medicaid began paying physicians and practices that administer COVID-19 vaccines $40 per dose to align with Medicare’s payment policy announced last month, the Texas Health and Human Services Commission (HHSC) announced. 

“For all COVID-19 vaccines, the (fee-for-service) administration reimbursement rate is $40 for each administration,” the agency said. “HHSC expects MCOs (managed care organizations) to modify their pharmacy and medical claims systems to reflect a $40 administration reimbursement for each dose administered.” 

Some of the Medicaid MCOs are still updating their claims systems to reflect the higher rate. If Medicaid fee for service or an MCO paid the previous rate on or after April 1, claims will be automatically reprocessed with the higher amount, according to HHSC.

Practices and physicians are required to administer vaccines to eligible recipients free of charge. 

As of this week, almost 12 million vaccine doses have been administered in Texas, according to the Texas Department of State Health Services.

There are numerous requirements and steps physicians and health care facilities must adhere to in order to administer vaccines.

Find more tools, resources, and information on TMA’s COVID-19 Resource Center, which is continually updated. 

Last Updated On

April 05, 2021

Originally Published On

April 05, 2021

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Coronavirus | Immunization | Medicaid