Medicare Compliance & Reimbursement

Question: With COVID-19 cases trending upwards, we’d like to stave off the double whammy of rising influenza cases. We are a little confused about Medicare’s annual flu season dates. What are they?

Oklahoma Subscriber

Answer: Payments for influenza vaccinations run from Aug. 1 to July 31 each year and are reimbursed at the nationally established rate of 95 percent of the average wholesale price (AWP), according to the Centers for Medicare & Medicaid Services (CMS) online flu shot guidance.

Additionally, CMS makes rate updates on a quarterly basis while administration payment rates are adjusted for each payment locality, notes Part B Medicare Administrative Contractor (MAC) National Government Services (NGS) in guidance.

Reminder: Influenza vaccinations are given per flu season and not by year, so Medicare beneficiaries can reasonably receive more than one booster a year as long as the immunization is medically necessary and the documentation is in the notes, indicated NGS Medicare’s Michelle Coleman CPC, in a webinar. “You can receive more than one flu vaccination per year,” she clarified. “The way we pay it is per season.”

For example, you could administer a flu shot in January 2022 — which falls under Medicare’s 2021/2022 reimbursement effective dates — and your patient could come in again in October 2022 for another vaccination because that is considered part of the 2022/2023 flu season.

You can find the most current list of flu vaccines that Medicare pays for with the payment allowances at www.cms.gov/Medicare/Medicare-Fee-for-Service-Part-B-Drugs/ McrPartBDrugAvgSalesPrice/VaccinesPricing.