CPT 91320 Medicare ASP Payment Limit 2026
Medicare's Part B payment limit for CPT 91320 is $230.41 per billing unit (1 dose) in the October 2026 ASP file, up 36.8% from $168.37 in 2025.
- Per 1 dose
- $230.41
- vs. 2025
- +36.8%
- Commercial national avg.
- $204.91
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Run a free sample reportSarscv2 Vac 30mcg Trs Suc Im, Severe Acute Respiratory Syndrome Coronavirus 2 Sarscov 2 Coronavirus Disease Covid 19 Vaccine Mrnalnp Spike Protein 30 Mcg 0 3 Ml Dosage Tris Sucrose Formulation For Intramuscular Use
| Code | Month | Year | Payment Limit | Description |
|---|---|---|---|---|
| 91320 - CPT | Jan | 2025 | $155.90 | Sarscv2 Vac 30mcg Trs Suc Im, Severe Acute Respiratory Syndrome Coronavirus 2 Sarscov 2 Coronavirus Disease Covid 19 Vaccine Mrnalnp Spike Protein 30 Mcg 0 3 Ml Dosage Tris Sucrose Formulation For Intramuscular Use |
| 91320 - CPT | Apr | 2025 | $155.90 | Sarscv2 Vac 30mcg Trs Suc Im, Severe Acute Respiratory Syndrome Coronavirus 2 Sarscov 2 Coronavirus Disease Covid 19 Vaccine Mrnalnp Spike Protein 30 Mcg 0 3 Ml Dosage Tris Sucrose Formulation For Intramuscular Use |
| 91320 - CPT | Jul | 2025 | $155.90 | Sarscv2 Vac 30mcg Trs Suc Im, Severe Acute Respiratory Syndrome Coronavirus 2 Sarscov 2 Coronavirus Disease Covid 19 Vaccine Mrnalnp Spike Protein 30 Mcg 0 3 Ml Dosage Tris Sucrose Formulation For Intramuscular Use |
| 91320 - CPT | Oct | 2025 | $168.37 | Sarscv2 Vac 30mcg Trs Suc Im, Severe Acute Respiratory Syndrome Coronavirus 2 Sarscov 2 Coronavirus Disease Covid 19 Vaccine Mrnalnp Spike Protein 30 Mcg 0 3 Ml Dosage Tris Sucrose Formulation For Intramuscular Use |
| 91320 - CPT | Jan | 2026 | $168.37 | Sarscv2 Vac 30mcg Trs Suc Im, Severe Acute Respiratory Syndrome Coronavirus 2 Sarscov 2 Coronavirus Disease Covid 19 Vaccine Mrnalnp Spike Protein 30 Mcg 0 3 Ml Dosage Tris Sucrose Formulation For Intramuscular Use |
| 91320 - CPT | Apr | 2026 | $168.37 | Sarscv2 Vac 30mcg Trs Suc Im, Severe Acute Respiratory Syndrome Coronavirus 2 Sarscov 2 Coronavirus Disease Covid 19 Vaccine Mrnalnp Spike Protein 30 Mcg 0 3 Ml Dosage Tris Sucrose Formulation For Intramuscular Use |
| 91320 - CPT | Jul | 2026 | $168.37 | Sarscv2 Vac 30mcg Trs Suc Im, Severe Acute Respiratory Syndrome Coronavirus 2 Sarscov 2 Coronavirus Disease Covid 19 Vaccine Mrnalnp Spike Protein 30 Mcg 0 3 Ml Dosage Tris Sucrose Formulation For Intramuscular Use |
| 91320 - CPT | Oct | 2026 | $230.41 | Sarscv2 Vac 30mcg Trs Suc Im, Severe Acute Respiratory Syndrome Coronavirus 2 Sarscov 2 Coronavirus Disease Covid 19 Vaccine Mrnalnp Spike Protein 30 Mcg 0 3 Ml Dosage Tris Sucrose Formulation For Intramuscular Use |
91320 payment limit by quarter
Each row is one quarterly CMS ASP file. Change is against the quarter before.
| Quarter | Payment limit per 1 dose | Change |
|---|---|---|
| October 2026 | $230.41 | +36.8% |
| July 2026 | $168.37 | No change |
| April 2026 | $168.37 | No change |
| January 2026 | $168.37 | No change |
| October 2025 | $168.37 | +8.0% |
| July 2025 | $155.90 | No change |
| April 2025 | $155.90 | No change |
| January 2025 | $155.90 | - |
The payment limit is Medicare's allowed amount per billing unit: the average sales price plus the statutory add-on. Medicare generally pays 80% of it after the Part B deductible, and the patient's coinsurance covers the rest. CMS recalculates it every quarter from manufacturer-reported sales.
91320: Medicare vs. commercial national average
The commercial national average for 91320, the mean of what BCBS, UnitedHealthcare, Aetna and Cigna publish nationwide, is $204.91 per 1 dose, 89% of Medicare's $230.41.
- BCBS $171.68
- UnitedHealthcare $167.58
- Aetna $302.01
- Cigna $178.36
A national average, not a local rate: each payer's figure averages the unmodified, in-network professional rates it publishes for 91320 across the country in its transparency files. Contracted rates vary widely by market, provider and plan. Medicare's figure is its current ASP payment limit per billing unit. Payers may bill the drug in a different unit, so compare the two with care.
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See what state Medicaid programs pay for 91320
50 state Medicaid agencies publish their own physician fee schedule. The 91320 page shows real published rates for several of them free, with effective dates and official sources.
17,674 codes and 974,327 published rates, taken from the files the state agencies publish themselves.
Methodology
Rates are sourced from CMS Part B Drug Average Sales Price (ASP) pricing files, published quarterly. Each HCPCS payment limit reflects the calculated ASP plus the statutory add-on for that quarter.
View CMS Part B ASP Pricing Files