Abstract
This study evaluated the uptake of Healthcare Common Procedure Coding System code M0201 after initial implementation to inform future policy related to in-home preventive care.
There were more than 1.6 million homebound adults aged 70 years or older in the US in 2019.1 These individuals have a high prevalence of frailty and chronic diseases, placing them at elevated risk of serious morbidity and mortality from vaccine-preventable illnesses, such as COVID-19 infection.2 However, homebound adults have difficulty accessing vaccines, which are most often administered at pharmacies and medical clinics.
In June 2021, responding to the pressing need to vaccinate vulnerable fee-for-service Medicare beneficiaries against COVID-19, the Centers for Medicare & Medicaid Services (CMS) implemented Healthcare Common Procedure Coding System (HCPCS) code M0201, which augmented reimbursement by approximately $35 for in-home COVID-19 vaccination.3 Little is known about the use of this financial incentive for in-home vaccination, the first of its kind for home-based preventive care. This study evaluated the uptake of M0201 after initial implementation to inform future policy related to in-home preventive care.
Methods
We performed a cross-sectional study using publicly available data from the CMS Provider Utilization and Payment Data Physician & Other Practitioners dataset from June 8, 2021, through December 31, 2021 (eMethods in Supplement 1).4 We identified all clinicians associated with greater than 10 billed claims for HCPCS code M0201, using both individual and organizational National Provider Identifier (NPI) numbers to identify clinician types (eg, physician, pharmacist). Rural-urban commuting area codes and zip codes were used to describe the rural-urban distribution of M0201 billing. To examine M0201 billing by areas of social vulnerability, we used the Centers for Disease Control and Prevention’s Social Vulnerability Index, a county-level percentile ranking by social factors (socioeconomic status, household characteristics, race and ethnicity, housing type, and transportation) ranging from 0 to 1, with higher values indicating greater vulnerability (eMethods in Supplement 1). The University of California, San Francisco institutional review board deemed this project exempt from review and informed consent. We performed our analysis in RStudio 2023.06.2.
Results
M0201 was billed 104 932 times between June and December 2021, representing 101 352 beneficiaries (Table). Pharmacies billed most M0201 claims (90.0%), representing 85.8% of unique NPIs associated with M0201 claims. Physicians, nurse practitioners, and physician assistants billed 8.7% of M0201 claims, representing 12.4% of NPIs.
Table. M0201 Claims From June 2021 to December 2021 by Clinician Type, Geography, and Community-Level Social Vulnerability.
| No. (%) | |||
|---|---|---|---|
| Unique NPIsa | Unique beneficiaries | Total vaccinations | |
| Overall | 865 | 101 352 | 104 932 |
| Clinician type | |||
| Pharmacy | 742 (85.8) | 91 654 (90.4) | 94 480 (90.0) |
| MD, DO, NP, PA | 107 (12.4) | 8469 (8.4) | 9132 (8.7) |
| Municipal health department | 16 (1.8) | 1229 (1.2) | 1320 (1.3) |
| Geographic category | |||
| Metropolitan | 711 (82.2) | 83 020 (81.9) | 85 925 (81.9) |
| Micropolitan | 79 (9.1) | 8473 (8.4) | 8791 (8.4) |
| Small town core | 57 (6.6) | 7155 (7.1) | 7330 (7.0) |
| Rural areas | 18 (2.1) | 2704 (2.7) | 2886 (2.8) |
| Social Vulnerability Index, quartileb | |||
| 1c | 127 (14.7) | 13 710 (13.5) | 14 399 (13.7) |
| 2 | 229 (26.5) | 23 110 (22.8) | 23 670 (22.6) |
| 3 | 241 (27.9) | 32 787 (32.3) | 33 624 (32.0) |
| 4 | 250 (28.9) | 29 906 (29.5) | 31 279 (29.8) |
| Missingd | 18 (2.1) | 1839 (1.8) | 1960 (1.9) |
Abbreviations: DO, doctor of osteopathy; MD, doctor of medicine; NP, nurse practitioner; NPI, National Provider Identifier; PA, physician assistant.
The Provider Utilization and Payment Data Physician & Other Practitioners dataset includes both individual clinician (type 1) NPIs and pharmacy organizational (type 2) NPIs. These data do not represent the total number of individuals billing M0201 because multiple clinicians (eg, pharmacists) would be able to bill M0201 under the same pharmacy organizational (type 2) NPI.
The Centers for Disease Control and Prevention’s Social Vulnerability Index is a composite percentile ranking based on 16 county-level social factors derived from the American Community Survey, 2016 to 2020. Social factors include county-level socioeconomic status, household characteristics, racial and ethnic minority status, and housing type and transportation, linked to the zip code of the billing clinician. Percentile ranking values range from 0 to 1, with higher values indicating greater vulnerability.
Quartiles represent the distribution of the Social Vulnerability Index of counties across the entire United States. Quartile 1 is the count of unique records (NPIs, beneficiaries, and total vaccinations) with values greater than 0 and less than or equal to 0.25. Quartile 2 is the count of unique records with values greater than 0.25 and less than or equal to 0.50. Quartile 3 is the count of unique records with values greater than 0.50 and less than or equal to 0.75. Quartile 4 is the count of unique records with values greater than 0.75 and less than or equal to 1.0.
Puerto Rico was not included in the computation of national percentiles and accounts for 17 of 18 missing NPIs.
Most M0201 claims (81.9%) were billed in metropolitan areas (Table). Micropolitan areas accounted for 8.4% of M0201 claims. Small towns and rural areas represented 7.0% and 2.8% of claims, respectively. Approximately twice as many M0201 claims were billed in counties in the highest quartile of social vulnerability (29.8%) compared with the lowest (13.7%) (Table). M0201 uptake occurred most prominently in population-dense areas (ie, Northeast and mid-Atlantic). Although most clinicians billed M0201 relatively few times, 48 clinicians (5.5%) billed more than 500 M0201 claims (Figure).
Figure. Geographic Location of Healthcare Common Procedure Coding System Code M0201 Claims Billed From June 2021 to December 2021.
Each marker represents the practice location of a clinician billing M0201 in the Provider Utilization and Payment Data Physician & Other Practitioners dataset from June 8, 2021, through December 31, 2021. The number of M0201 claims billed by each clinician is represented by color.
Discussion
A novel HCPCS code, M0201, designed to incentivize in-home COVID-19 vaccination for homebound fee-for-service Medicare beneficiaries, was used predominantly by pharmacies and in metropolitan areas during the first 6 months of implementation. M0201 may incentivize mass immunizers—commonly pharmacies5—who have the resources to increase the volume of in-home vaccinations. Individual clinicians may not have used M0201 as frequently because it could not be billed in conjunction with other evaluation and management codes used during routine in-home care.6 Further qualitative studies should explore reasons for variable uptake among pharmacies and individual clinicians.
This study has limitations. First, Medicare public use files include only fee-for-service beneficiary claims and clinicians with greater than 10 billed procedure codes. Second, although this research encompasses all publicly available data for M0201, it represents only the first 6 months of implementation. Third, results do not reflect the total number of COVID-19 vaccines administered to homebound individuals (eg, due to slow uptake or inability to bill M0201 with other medical care). This study’s primary goal was to describe M0201 uptake rather than estimate total COVID-19 vaccine administrations for homebound persons.
Because M0201 has expanded in 2024 to incentivize in-home influenza, pneumococcus, and hepatitis B immunization, further study should investigate the characteristics of patients receiving in-home vaccination and M0201’s effect on health equity in immunization.
Section Editors: Kristin Walter, MD, and Jody W. Zylke, MD, Deputy Editors; Karen Lasser, MD, MPH, Senior Editor.
eMethods. Supplemental Methods
eReferences.
Data Sharing Statement
References
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
eMethods. Supplemental Methods
eReferences.
Data Sharing Statement
