Internal Medicine Coding Alert

Published on Mon Oct 25, 2010 PDF

Don't bill separately for vaccination supplies, intermediary warns.

With fall comes flu season, and a round of questions about billing for flu vaccinations.

Tip #1: Medicare covers only one flu vaccination per flu season per beneficiary, unless a physician notes in the medical record that an additional vaccination is reasonable and medically necessary, the Centers for Medicare & Medicaid Services says in an MLN Matters article about the vaccinations (SE1026, September 15, 2010).

You can actually follow this rule and still vaccinate a patient twice in a single year. For example, a beneficiary could receive a flu shot in January 2010 for one flu season, then in November 2010 for the next flu season.

Tip #2: Medicare pays for the vaccine and administration, regional intermediary Palmetto GBA notes in a frequently asked question on its website. "The cost associated with the syringe and supplies are included in the administration fee and not separately billed," Palmetto instructs.

Tip #3: Don't charge beneficiaries a co-pay or deductible. Even if you're furnishing vaccinations in a flu shot clinic or other non-home setting, you still don't need to charge a coinsurance or deductible for the preventive service. Instead, bill Medicare for the cost of the vaccination and its administration. Remember that Medicare allows for roster billing when you administer the flu vaccine to a number of beneficiaries at one location.

Resource: Medicare beneficiaries normally fall into a highrisk category for flu, which is why every beneficiary is encouraged to be vaccinated each flu season. If your office does not have the vaccine available, refer Medicare patients to 1-800-MEDICARE (1-800-633-4227) for help locating their state health department.