12.6.21

THANKS, TAXPAYERS.

The latest Medicare statement of outpatient claims includes some interesting stuff.  A dose of the Moderna coronavirus vaccine (billing code 91301) is a service not approved by Medicare, although the facility bills Medicare for $0.01 per stick.  The administration of the shots is a separate service, the first dose has billing code 0011A, and the facility charges $125, out of which Medicare pays $15.95.  The second dose has a separate billing code, 0012A, but Medicare pays $26.23 out of that $125.  All of that might come out of my pocket anyway, as Irma A says I'm doing pretty well in retirement.

Where, though, is the market test that comes up with that $125 or that actuarial calculation, or whatever, that reimburses the first dose at $15.95 and the second at $26.23?

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