OASIS Alert

Published on Sun Oct 03, 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 at www.cms.gov/MLNMattersArticles/downloads/SE1026.pdf.

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 home health 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 copay 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, Palmetto explains in a separate FAQ. "A provider must ensure that condition code A6 is included on the claim to ensure that no coinsurance or deductible is taken," Palmetto says.

Resource: To access Palmetto's FAQs, go to www.palmettogba.com, click on "Regional Home Health Intermediary (RHHI)" in the left column, then click on "Resources" in the left column, and then click on "FAQs."