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Billing if Medicare Doesn't cover it

  1. #1
    Default Billing if Medicare Doesn't cover it
    Medical Coding Books
    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?

  2. #2
    Seacoast- Dover New Hampshire
    We have the pt pay up front and do not bill MCR. They can submit to their 2ndry
    Karen Barron, CPC
    Hampton New Hampshire Chapter

  3. #3
    North Carolina
    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.

  4. #4
    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.

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