Results 1 to 4 of 4

Part D Vaccinations

  1. #1
    Default Part D Vaccinations
    Medical Coding Books
    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.
    Jennifer Stauffer, CPC

  2. #2

    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


  3. #3
    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.

  4. #4
    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

Similar Threads

  1. Vaccinations
    By nkawtgn in forum Family Practice
    Replies: 1
    Last Post: 09-20-2015, 10:44 AM
  2. Vaccinations--Please help!!
    By kmasters in forum Medical Coding General Discussion
    Replies: 9
    Last Post: 11-24-2009, 07:43 AM
  3. vaccinations - cpt code
    By grams1 in forum Pediatrics
    Replies: 1
    Last Post: 10-02-2009, 08:13 AM
  4. vaccinations
    By pskinner in forum Medical Coding General Discussion
    Replies: 2
    Last Post: 01-01-2009, 03:23 AM
  5. Vaccinations
    By dawn1170 in forum Family Practice
    Replies: 5
    Last Post: 03-13-2008, 08:36 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.