Double-check Medicare Part D vaccines for reimbursement

The Centers for Medicare and Medicaid Services recently announced changes in reimbursement available to physicians for vaccines administered to Medicare beneficiaries in the latest issue of MLN Matters.

The publication details changes for 2008 in vaccine reimbursement and vaccine administration under Medicare Part D and distinguishes which vaccines should be billed under Part B and which should be billed under Part D. Most vaccines are covered under Part B—including vaccines for pneumonia, influenza, Hepatitis B, and others related to the treatment of an injury or direct exposure to a disease or condition—while the Part D program generally covers the vaccines not available under Part B.

The difference between Part B and Part D is in billing. The physician administering the vaccine may not be able to directly bill the Part D sponsor for the vaccine and its administration and may have to work with the beneficiary and the Part D plan for reimbursement. This doesn’t mean physicians won’t be reimbursed, but rather means the physician must contact the Part D plan about coverage and other supporting information needed.

For more information, including a list of vaccines covered under the Part B and Part D programs, read the current issue of MLN Matters, issue SE0727, or visit the CMS Web site.