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Thread: Billing if Medicare Doesn't cover it

  1. #1
    Join Date
    Apr 2007

    Default Billing if Medicare Doesn't cover it

    AAPC: Back to School
    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
    Join Date
    Apr 2007
    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
    Join Date
    Apr 2007
    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
    Join Date
    Apr 2007
    Colorado Springs


    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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