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New for 2008:
Medicare Part D Vaccine Administration
Due to a statutory shift, vaccines identified by the Centers for Medicare and Medicaid Services (CMS) as covered by Part D must be billed for under Part D, which includes the vaccine administration. As of January 1, 2008, Part D eligible vaccines are zostavax, haemoph B, papillomavirus, encephalitis, MMR, meningococcal, polio, rabies, typhoid, varicella, etc…
CMS guidelines are helpful in understanding this new Medicare program, the various options and service combinations. For your convenience, the following information is provided:
The best source of program information can be found on the CMS Web site at http://www.cms.hhs.gov/MLNMattersArticles/2007MMAN/list.asp
- SE0678 Payment for Part D Vaccines under the Medicare Drug Benefit (Part D) (Program overview)
- SE 0727 Reimbursement for Vaccines & Vaccine Administration Under Medicare Part D (Additional program information)
- SE 0723 Revised-Important Notice Regarding Vaccine Administration in 2008 (for billing codes; be sure to see the Additional Information section of this CMS guide)
There are no changes to rules or reimbursement for Part B covered vaccines. Examples of Part B eligible vaccines are influenza or pneumococcal. Other vaccines such as hepatitis B or tetanus may be Part B or Part D. Click here for an abridged list of Part D and Part B vaccines. Payment decision will be based on the CMS criteria.
CMS criteria for determining if a medication should be paid under Part B or Part D can be found in:
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