Practice Management Alert

Question: Our office is beginning to give vaccines that Part D covers rather than Part B, such as the shingles vaccine. How should I bill for these vaccine administrations?

Tennessee Subscriber

Answer: For a little while longer, you can bill Part B Medicare for administering the shingles vaccine. On Jan. 1, 2007, CMS implemented G0377 (Administration of vaccine for Part D drug) specifically for practices to report Part D vaccine administrations, including the new herpes Zoster vaccine.

How it works: You should bill G0377 as you do any other G code you use for administering vaccines covered under Part B. Submit your claims for G0377 to your Medicare carrier. You can expect the same payment on G0377 as you get for vaccine administration code 90471 (Immunization administration [includes percutaneous, intradermal, subcutaneous, or intramuscular injections]; one vaccine [single or combination vaccine/toxoid]).

Upcoming changes: In 2008, you won't bill Part B for the vaccine administration. Medicare plans to delete vaccine administration code G0377 on Jan. 1, according to MLN Matters articles SE0723 and SE0727 (http://www.cms.hhs.gov/MLNMattersArticles). You-ll have to bill the patient directly for both the vaccine and its administration, "and the patient will need to submit the claim to their Part D plan for reimbursement," according to MLN Matters article SE0723.

Get the details: MLN Matters article SE0727 also says that providers "should contact Part D plans regarding specific vaccine administration fees for 2008" -- which suggests that you could bill the Part D plan directly instead of billing the patient.

Best bet: Next year, you should plan to collect money from the patient upfront and then allow the patient to bill the Part D plan. Because Medicare won't pay for the vaccine administration, you won't need to ask the patient to sign an advance beneficiary notice (ABN). You may still want to get a signed notice of exclusions from Medicare benefits (NEMB), however, to ensure the patient clearly understands that Medicare won't pay for the administration.

Note: You-ll still bill Medicare Part B for pneumococcal pneumonia vaccines, influenza virus vaccines and, for high-risk individuals, hepatitis B vaccines.