FI/AB MAC Payment for Pneumococcal Pneumonia Virus, Influenza Virus, and Hepatitis B Virus Vaccines and Their Administration (Rev. 1586, 10-06-08)

by  Jared Staheli
June 25th, 2015

Payment for Vaccines

Payment for all of these vaccines is on a reasonable cost basis for hospitals, home health agencies (HHAs), skilled nursing facilities (SNFs), critical access hospitals (CAHs), and hospital-based renal dialysis facilities (RDFs). Payment for comprehensive outpatient rehabilitation facilities (CORFs), Indian Health Service hospitals (IHS), IHS CAHs and independent RDFs is based on 95 percent of the average wholesale price (AWP). Section 10.2.4 of this chapter contains information on payment of these vaccines when provided by RDFs or hospices. See §10.2.2.2 for payment to independent and provider- based Rural Health Centers and Federally Qualified Health Clinics.

Payment for these vaccines is as follows:

Payment for Vaccine Administration

Payment for the administration of influenza virus and pneumococcal vaccines is as follows:

Guidelines for pricing pneumococcal and influenza virus vaccine administration under the MPFS.

Make reimbursement based on the rate in the MPFS associated with the CPT code 90782 or 90471 as follows:

See §10.2.2.2 for payment to independent and provider based Rural Health Centers and Federally Qualified Health Clinics.

Payment for the administration of hepatitis B vaccine is as follows:

Guidelines for pricing hepatitis B vaccine administration under the MPFS.

Make reimbursement based on the rate in the MPFS associated with the CPT code 90782 or 90471 as follows:

See §10.2.2.2 for payment to independent and provider based Rural Health Centers and Federally Qualified Health Clinics.

References:

• Pub 100-04 Medicare Claims Processing Manual - Chapter 18