Loading...

    Explore
    • Policy Monitoring
    • Live Policy Feed
    • Billing Codes
    • NPI Medicare & Medicaid
    • Healthcare Providers
    • Health Insurance Payers
    • States
    • Service Lines
    • Taxonomy Codes
    Lookup tools
    • Billing Code Lookup
    • CPT Modifier Lookup
    • Provider Taxonomy Code Lookup
    • Healthcare Provider & Facility Lookup
    • Health Insurance Payer Lookup
    • Payer Contact Directory

    Policy & Benchmark Tools

    • Prior Authorization Lookup
    • Coverage Criteria Lookup
    • Timely Filing Lookup
    • Billing Code Reimbursement Rates
    • Payer Comparison Dashboard
    • Facility Comparison Dashboard
    • All tools

    Company

    • About OpenPayer
    • Data Sources
    • Trek Health
    OpenPayerby Trek Health
    LinkedInYouTube

    © 2026 Trek Health. All rights reserved.

    OpenPayer is built and maintained by Trek Health.

    v1.0.30
    OpenPayerBilling CodesMiscellaneous Medical ServicesHCPCS hcpcs-m0201-in-home-vaccine-administration
    Ask Trek AI about this page

    HCPCS Level II M0201: In-Home Vaccine Administration

    HCPCS Level II code M0201 describes administration of pneumococcal, influenza, hepatitis B, and/or COVID-19 vaccines delivered inside a patient’s home; this code represents a vaccine administration service provided in the home setting and is reported once per individual home per date of service when one or more of the listed vaccines are given during that visit.

    For related coverage guidance, see recent payer policy updates: Skilled Nursing and Skilled Rehabilitation Services (Outpatient), Habilitation and Rehabilitation Therapy (Occupational, Physical, and Speech) (for New Mexico Only), Physical Therapy/Medicine Corporate Medical Policy.

    Customize your policy alerts

    Sign up for hcpcs M0201 policy alerts

    Get alerted when payer policies referencing M0201 are released or updated.

    Monitor payer policy activity

    Receive email alerts as soon as relevant payer policies are published or updated.

    Table of contents

    Progress1 / 7

    Explore openpayer tools

    • Billing CodesCPT, HCPCS, DRG & more
    • Reimbursement RatesCommercial vs. Medicare rate reports
    • Facility ComparisonBeds, revenue & payer mix
    • ProvidersHospitals & facilities
    • PayersPlans & market footprint
    • Taxonomy CodesNUCC specialty codes
    • ModifiersCPT modifiers & usage
    • Prior AuthorizationPA policies by payer & drug
    • Timely FilingFiling deadlines by payer
    • Coverage CriteriaMedical necessity by payer
    • Payer ContactsClaims, PA & appeals contacts
    View all tools

    Clinical & Coding Specifications

    Clinical Context

    A home health nurse from a primary care practice visits an 82-year-old homebound patient with chronic obstructive pulmonary disease (COPD) and congestive heart failure to administer seasonal influenza and pneumococcal vaccines. The patient has limited mobility and difficulty traveling to clinic appointments. The nurse confirms identity, reviews vaccine consent and immunization history, performs a focused screening for contraindications (allergy, acute moderate/severe illness), documents lot numbers, expiration dates, and injection sites in the medical record, and observes the patient for 15 minutes for immediate adverse reactions. The vaccines are provided and administered in the patient’s home; the visit is billed using M0201 once for that home on the date of service. If additional vaccine-related supplies or remote supervision are needed, those are documented separately. Immunization counseling and vaccine education are included in the encounter documentation.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    90732Influenza virus vaccine, quadrivalent, split virus, preservative free, for intramuscular useCommon vaccine administered during the same home visit billed with M0201 for in-home administration
    90670Pneumococcal 23-valent polysaccharide vaccine, adult dosage, for subcutaneous or intramuscular useFrequently co-administered to eligible adults during home-based vaccine encounters
    91300COVID-19 vaccine, mRNA, spike protein, 30 mcg dosage, 0.3 mL dose (Comirnaty), for intramuscular useCOVID-19 vaccine that may be administered in the home; administration reported via M0201 for the home service
    90744Hepatitis B vaccine, dialysis or high-risk schedule, adult dosageHepatitis B vaccine formulations used in adult immunization programs; may be administered in homebound patients
    90471Immunization administration (intramuscular, subcutaneous); single or first componentProcedure code for the act of vaccine administration that is related clinically to the services performed during the visit

    Related Modifiers

    7 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    23Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
    80CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    363LF0000X
    207Q00000X
    367A00000X
    2865C1500X
    103TH0100X
    224L00000X
    2081N0008X
    363LP1700X

    Related ICD-10-CM Codes

    21 rows

    ICD-10-CM CodeDescription
    D50.9Iron deficiency anemia, unspecified
    D63.8Anemia in other chronic diseases classified elsewhere
    E11.9Type 2 diabetes mellitus without complications
    E78.5Hyperlipidemia, unspecified
    F03.90Unspecified dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety
    G30.9Alzheimer's disease, unspecified
    I10Essential (primary) hypertension
    I50.9Heart failure, unspecified
    J00Acute nasopharyngitis [common cold]
    J06.9Acute upper respiratory infection, unspecified

    Showing 1–10 of 21

    Related Payer Policy Updates

    Specialty: Physical Medicine, Rehab & Therapies1 / 3

    10 rows

    PolicyPayerEffective Date
    Skilled Nursing and Skilled Rehabilitation Services (Outpatient)Anthem2026-10-01
    Habilitation and Rehabilitation Therapy (Occupational, Physical, and Speech) (for New Mexico Only)UnitedHealthcare2026-10-01
    Physical Therapy/Medicine Corporate Medical Policybcbsvermont2026-10-01
    Speech Language Pathology/Therapy Services Corporate Medical Policybcbsvermont2026-10-01
    Cognitive Rehabilitation Corporate Medical Policybcbsvermont2026-10-01
    Occupational Therapy Corporate Medical Policybcbsvermont2026-10-01
    Biomagnetic TherapyConnectiCare2026-09-11
    Habilitation and Rehabilitation Therapy (Occupational, Physical, and Speech) (for Idaho Only)UnitedHealthcare2026-09-01
    Rehabilitation Services (Physical, Occupational, and Speech Therapy)UnitedHealthcare2026-09-01
    Manipulative Therapy (for Tennessee Only)UnitedHealthcare2026-09-01

    Related Codes

    HCPCS-M0075-CELLULAR-THERAPY-PROCESSING-PROVISION

    HCPCS Level II M0075: Cellular Therapy

    HCPCS-M0076-PROLOTHERAPY-INJECTION-THERAPY

    HCPCS Level II M0076: Prolotherapy

    HCPCS-M0100-INTRAGASTRIC-HYPOTHERMIA-GASTRIC-FREEZING

    HCPCS Level II M0100: Intragastric Hypothermia (Gastric Freezing)

    HCPCS-M0220-TIXAGEVIMAB-CILGAVIMAB-PRE-EXPOSURE-PROPHYLAXIS

    HCPCS Level II M0220: Tixagevimab and Cilgavimab Pre-Exposure Prophylaxis

    HCPCS-M0221-TIXAGEVIMAB-CILGAVIMAB-PRE-EXPOSURE-PROPHYLAXIS-HOME-ADMINISTRATION

    HCPCS M0221: Tixagevimab and Cilgavimab Pre-Exposure Prophylaxis

    HCPCS-M0222-BEBTELOVIMAB-INTRAVENOUS-INJECTION-MONITORING

    HCPCS Level II M0222: Bebtelovimab Intravenous Injection with Monitoring

    HCPCS-M0223-BEBTELOVIMAB-INTRAVENOUS-INJECTION-HOME-MONITORING

    HCPCS M0223: Intravenous Bebtelovimab with Home Monitoring

    HCPCS-M0224-PEMIVIBART-PRE-EXPOSURE-PROPHYLAXIS-INFUSION

    HCPCS M0224: Pemivibart Intravenous Infusion for Pre-Exposure Prophylaxis

    HCPCS-M0233-TOCILIZUMAB-INFUSION-COVID19-HOSPITALIZED-ADULTS

    HCPCS Level II M0233: Tocilizumab-aazg IV Infusion, First Dose

    HCPCS-M0234-TOCILIZUMAB-INFUSION-HOSPITALIZED-COVID19

    HCPCS Level II M0234: Tocilizumab Infusion for Hospitalized Adults with COVID-19

    Showing 1–10 of 27

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
    Published by

    Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

    Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.