Immunization Toolkit

CMS - QUICK REFERENCE INFORMATION: MEDICARE PART B IMMUNIZATION BILLING

GEORGIA IMMUNIZATION STUDY 2006 Final Report
Georgia Department of Human Resources | Division of Public Health
Epidemiology Branch | Maternal and Child Health Section | Immunization Program http://health.state.ga.us/pdfs/publications/reports/gaimmunizationstudy.06.pdf

Can Registered Nurses In The Hospital Setting Administer Influenza Virus Vaccines Pursuant To A Standing Order Under Georgia Law ?

The Centers for Medicare & Medicaid Services has released the following Special Edition MLN Matters article, SE0748 2007 - 2008 Influenza (Flu) Season Resources for Health Care Professionals, located at http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0748.pdf, on the CMS website.

AHRQ Guidelines:
Influenza vaccination and management, including CDC's annual influenza recommendations! See also the QualityTools Web site for additional influenza resources.

Prevention and Control of Influenza -PPRecommendations of the Advisory Committee on Immunization Practices (ACIP), 2007

Medicare’s Influenza Season Resources http://www.cms.hhs.gov/MLNProducts/Downloads/flu_products.pdf.

Immunization Cost Reimubursement
10.2.2 - Bills Submitted to FIs
(Rev. 681, Issued: 09-16-05; Effective: 01-01-06; Implementation: 01-03-06)
The applicable types of bills acceptable when billing for influenza and PPV are 12X, 13X, 22X, 23X, 34X, 72X, 75X, 83X and 85X.

The following revenue codes are used for reporting vaccines and administration of the vaccines for all providers except RHCs and FQHCs. Independent and Provider Based RHCs and FQHCs follow §10.2.2.2 below when billing for influenza, PPV and hepatitis B vaccines.

Units and HCPCS codes are required with revenue code 0636:

In addition, for the influenza virus vaccine, providers report condition code M1 in Form Locator (FLs) 24-30 when roster billing. See roster billing instructions in §10.3 of this chapter.

When vaccines are provided to inpatients of a hospital or SNF, they are covered under the vaccine benefit. However, the hospital bills the FI on bill type 12X using the discharge

date of the hospital stay or the date benefits are exhausted. A SNF submits type of bill 22X for its Part A inpatients.

10.2.2.1 - FI Payment for Pneumococcal Pneumonia Virus, Influenza Virus, and Hepatitis B Virus Vaccines and Their Administration
(Rev. 890, Issued: 03-17-06; Effective: 07-01-06; Implementation: 07-03-06)
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:

www.cms.hhs.gov
Internet only manual
100-4
Chapter 18.

If you are having trouble accessing these resources, please contact us at: pha@gha.org