Wiki Part D Vaccinations

[jjstauffer62]

Hi-
I was wondering, if a patient is supposed to get their vaccinations through Part D (other than the normal flu, pneumonia, etc. Is it okay for the patient to bring vaccinations to the office and we just bill the appropriate administration codes for them. Would there be any special billing notes, modifiers, etc attached to the admin codes? Any help would be appreciated.
Thanks,
Jennifer Stauffer, CPC

 

[lmcbrayer]

Jennifer,

Everything that I have read and talked to a couple of plans about Part D vaccines states that if a provider is going to offer the vaccines then provider must have in clinic, adminster to patient, send claim to patient to file to their Part D plan, and also collect at time of service from the patient. The Part D plan will reimburse the patient. Check in the CMS manual - Prescription Drug Benefit Manual Chapter 5: Benefits and Beneficiary Protections Section 60.2 and Chapter 6 – Part D Drugs and Formulary Requirements - Section 10.14

 

[jjstauffer62]

Thanks Linda-We did administer the vaccinations, but billed them through Part B, but then I was notified that the patient received a denial (?) stating that it should have went through Part D. Patient rec'd several vaccinations, (post-splenectomy patient). Okay, let me do some research.

 

[jjstauffer62]

Also, when we collect from the patient is it at the Medicare Approved rate/FFS? Do we need a waiver and a modifier on the claim to go to Medicare or are we not going to send a claim at all, since we are collecting from patient and then they are billing Part D. Thanks for any information you can provide, your chapters and sections were point-on! Thanks again, Jennifer Stauffer