November 2004 Newsletter

Vaccines in Part B

By: , Quality Assurance

Medicare Part B Influenza & Pneumococcal Vaccine Coverage

Influenza Vaccine (Flu)

The vaccine and its administration are available only under Medicare Part B, regardless of where the vaccine is furnished. Beneficiaries do not pay the usual deductible or coinsurance amounts. Medicare pays those amounts in addition to an amount for the vaccine and the person who administers the shot. The beneficiary may receive the vaccine upon request without a physician's order or supervision.

Coding

Bill flu shots using diagnosis code V04.81.

Use Physicians' Current Procedural Terminology (CPT®) codes 90657 or 90658 when billing the flu shots. These codes are for the vaccine only. Bill the administration of the flu shots using HCPCS code G0008.

Pneumococcal Vaccine (PPV)

Medicare beneficiaries who get the vaccine do not pay the usual coinsurance or deductible amounts. Medicare pays 100% of the allowed amount for the vaccine and the administration. Typically these vaccines are administered once in a lifetime to persons at high risk of pneumonia infection. Medicare requires that a physician must order the vaccine.

Coding

Bill the PPV using diagnosis code V03.82.

Bill the PPV vaccine using CPT® code 90732. This code is for the vaccine only. Administration of Pneumococcal vaccine is billed using HCPCS code G0009.