Effective January 1, 2008, Medicare changed how it covers vaccines and administration services relating to those covered under the Part D program. PriorityMedicareSM has also updated policies and processes to reflect this change.
PriorityMedicare will no longer reimburse certain vaccine administration services when the vaccine itself is covered under the Medicare Part D program. Please note that vaccine administration services performed in conjunction with a vaccines that is covered under the Part B program will remain unchanged.
PriorityMedicare currently covers hepatitis A, rabies and tetanus vaccines (under the Part B program) for members when specific criteria are met and the appropriate diagnosis is reported. The administration of these vaccines will also be covered under Part B as long as the appropriate diagnosis is reported.
PriorityMedicare currently covers vaccines such as hepatitis B, influenza and pneumococcal along with the administration of these vaccines. The appropriate G code for administration of these vaccines should be reported in order to accurately apply the vaccine administration benefits. If the provider bills a 90471 or 90472 for the three vaccines listed above, these services may deny as a non-covered services based on the new Medicare benefit.
- G0008 - Administration of influenza virus vaccine
- G0009 - Administration of pneumococcal vaccine
- G0010 - Administration of hepatitis B vaccine
This information has been updated in the Provider Manual. Additional information regarding these changes can be located at the CMS website. MLN Matters articles MM5443 and M5459 specifically address these changes.
Last modified
04/01/08
