Wiki Shingles Vaccines: Medicare Advantage Plans

[meghanduggan]

I'm part of an FQHC we are billing Shingles vaccines how is your practice handling administration of them?

We're finding almost none of the medicare replacement plans will pay them. They either redirect the billing to a pharmacy coverage, and they deny because the med wasn't administered in a pharmacy, or they deny stating that WE need to bill the patient's medicare part D coverage.

 

[lgardner]

we send an Rx for the shingles vaccines to the pt's pharmacy. if the patient really wants to get it the office, they must pay upfront and they can submit to Medicare part D for reimbursement.
Shingles is only covered by part D and is not paid if given in the office.

here is a link to the MLN publication on Medicare Part D Vaccines:

MLN - Medicare Part D Vaccines

 

[meghanduggan]

This was very Helpful. Thank you.