Wiki Billing if Medicare Doesn't cover it

[lkerrison]

Do you have to bill a service if Medicare doesn't cover it?
Example: Since Medicare does not cover the Shingles vaccine, do you have to bill it through them anyway, or can you charge cash only for the service?

 

[kbarron]

We have the pt pay up front and do not bill MCR. They can submit to their 2ndry

 

[RebeccaWoodward*]

Your provider will need to bill the patient for the vaccine and its administration. However, if the beneficiary is enrolled in Part D, payment for the Part D covered vaccine is made by the participating prescription drug plan.

 

[britbrit852003]

I bill Medicare for these non-covered services so we can get a denial and so that the patient cannot come back and say that its a covered service. Also there are modifiers you can attach to tell Medicare that you know this is a non-covered service.
GY and GZ these can be found in the HCPCS book.