Billing Medicare Part B and Medicare Part D

Medicare provides reimbursement for immunizations depending on the type of vaccine and coverage offered.

Vaccines Typically Billed Under Medicare Part B	Vaccines Typically Billed Under Medicare Part D
Seasonal Influenza Pneumococcal Polysaccharide Hepatitis B (high- or intermediate-risk) Other, if related to the treatment of an injury or direct exposure to a disease or condition	Pertussis (e.g., Tdap) Tetanus (e.g., Td) Hepatitis B (NOT high- or intermediate-risk) Measles, mumps and rubella (e.g., MMR) Polio Varicella (Chicken Pox) Shingles Meningitis Rabies Typhoid Other, in absence of injury or direct exposure

To become a Medicare Part B Provider consult the Immunization Program Guide’s reimbursement section under Billing and Coding.

To submit a Medicare Part B Claim locate the summary of codes and pricing for vaccines covered under Medicare Part B.

Billing Codes	When administering seasonal influenza, pneumococcal or hepatitis B vaccinations (in high- or intermediate-risk patients), Medicare pays a separate rate for (1) the cost of the vaccine and (2) the cost of administering the vaccine. You will need two codes to bill.
Co-payment	Patients do not need to pay a co-payment or meet their deductible to receive the influenza or pneumococcal vaccines. For hepatitis B vaccines, the coinsurance or co-payment applies after the yearly deductible has been met.
Prescription Requirements	Medicare Part B does not require physicians to prescribe the influenza or pneumococcal vaccines, but state laws might require a prescription for pharmacy/pharmacist administration. to find your specific state information. Use the Immunization Module in the Bula Regulatory Compliance Tool to find your specific state information.

Medicare Part B Roster Billing/Mass Immunizations (Influenza and Pneumococcal Vaccinations ONLY)

Medicare vaccines may be billed by submitting individual claims or by roster billing by “mass immunizers." Roster billing allows you to submit one claim for all the Medicare beneficiaries that received any vaccine on a given day. Providers that choose to be mass immunizers must apply to CMS for the designation. Roster billing can be done electronically or by paper. However, roster billing is considered a paper claim; and therefore, may be paid less quickly than electronic claims.

To submit a Medicare Part B claim with roster billing, submit a completed CMS-1500 form for each type of vaccination along with the attached roster bill. Paper claims are accepted, but many local carriers offer low- or no-cost software for providers to roster-bill electronically.

REFERENCES
CMS, Medicare Enrollment and Claim Submission Guidelines
CMS, Quick Reference Information
2012–2013 Immunizers’ Question & Answer Guide to Medicare Part B, Medicaid and CHIP Coverage of Seasonal Influenza and Pneumococcal Vaccinations
Reimbursement for Vaccines and Vaccine Administration Under Medicare Part D