Mps Immunization Billing Quick Reference Chart
MEDICARE PREVENTIVE SERVICES
QUICK REFERENCE INFORMATION:
MEDICARE PART B IMMUNIZATION BILLING
(Influenza, Pneumococcal, and Hepatitis B)
Immunization Procedure Codes & descriptors
What’s new?
AdmInIstrAtIon
Since Medicare reimbursement rates change periodically,
& dIAgnosIs Codes
VACCIne Codes & desCrIPtors
FrequenCy oF
AdmInIstrAtIon
providers are encouraged to enroll in CMS listservs of
90655 – Influenza virus vaccine, split virus, preservative free, when administered to
their choice at:
children 6-35 months of age, for intramuscular use.
http://www.cms.hhs.gov/AboutWebsite/EmailUpdates
Once per flu
for the latest updates.
90656 – Influenza virus vaccine, split virus, preservative free, when administered to
Influenza Virus Vaccine
season in the
individuals 3 years and older, for intramuscular use.
Institutional Providers:
fall or winter.
Administration Code: g0008
Additional Billing Information
90657 – Influenza virus vaccine, split virus, when administered to children 6-35 months
Medicare may
diagnosis Code: V04.81
of age, for intramuscular use.
cover additional
FACIlIty
tyPe
flu shots
oF BIll
90658 – Influenza virus vaccine, split virus, when administered to individuals 3 years of
if medically
age and older, for intramuscular use.
necessary
Hospitals and Indian Health Service
(IHS) Hospitals [other than Critical
12x, 13x
Access Hospitals (CAHs)]
90660 – Influenza virus vaccine, live, for intranasal use.
CAHs: Method I and II and IHS CAHs
12x, 85x
Pneumococcal
Vaccine
90669 – Pneumococcal conjugate vaccine, polyvalent, when administered to children
Skilled Nursing Facilities (SNFs)
22x, 23x
younger than 5 years, for intramuscular use.
Once in a lifetime /
Medicare may
Administration Code: g0009
Home Health Agencies (HHAs)
34x
cover additional
90732 – Pneumococcal polysaccharide vaccine, 23-valent, adult or immunosuppressed
diagnosis Code: V03.82
patient dosage, when administered to individuals 2 years or older, for
vaccinations
Independent and Hospital-Based
subcutaneous or intramuscular use.
based on risk
Renal Dialysis Facilities
72x
Pneumococcal and
Comprehensive Outpatient
Influenza Virus Vaccines
Rehabilitation Facilities (CORFs)
75x
received during the
Follow
administration
Revenue Codes: 0636 - vaccine
same visit
Use influenza virus and pneumococcal vaccine codes.
guidelines for
0771 - administration
Administration Codes:
influenza virus and
g0008: Influenza Virus
pneumococcal
special Information for rural Health
g0009: Pneumococcal
vaccines
Clinics (rHCs) and Federally qualified
diagnosis Code: V06.6
Health Centers (FqHCs):*
Hepatitis B Vaccine
FACIlIty
tyPe
oF BIll
Administration Codes:
90740 – Hepatitis B vaccine, dialysis or immunosuppressed patient dosage (3 dose
g0010
schedule), for intramuscular use.
Rural Health Clinic (RHC)
71x
(for other than
oPPs hospitals)
90743 – Hepatitis B vaccine, adolescent (2 dose schedule), for intramuscular use.
Federally Qualified
Health Center (FQHC)
73x
For oPPs hospitals billing
90744 – Hepatitis B vaccine, pediatric/adolescent dosage (3 dose schedule),
Scheduled doses
for the hepatitis B vaccine
for intramuscular use.
required
*Influenza virus, pneumococcal, and hepatitis B
administration:
vaccines are covered when given by RHCs and FQHCs
when they meet all program requirements, but no line
90471
90746 – Hepatitis B vaccine, adult dosage, for intramuscular use.
Immunization administration
items specifically for vaccines are billed on type of bill
71x or 73x claims. The cost of the influenza virus and
90472
90747 – Hepatitis B vaccine, dialysis or immunosuppressed patient dosage (4 dose
pneumococcal vaccines and the vaccine administration
each additional vaccine
schedule), for intramuscular use.
is reported separately on the RHC’s and FQHC’s cost
diagnosis Code: V05.3
report for reimbursement purposes.
CPT only copyright 2008 American Medical Association. All Rights Reserved.
Frequently Asked questions
quick Facts!
Does a Part B deductible or coinsurance apply for adult immunizations covered by Medicare?
• Enrolled providers may roster bill for flu and pneumococcal
Neither a Part B deductible nor coinsurance applies to the influenza virus or pneumococcal vaccines. However, the Part B deductible
vaccinations even if they are not a mass immunizer.
plus the 20 percent Medicare coinsurance amount applies to the hepatitis B vaccine.
• All physicians, non-physician practitioners, and suppliers who
If a beneficiary receives a flu vaccination more than once in a 12-month period, will Medicare still pay for it?
administer the influenza virus vaccination and the pneumococcal
Yes. Medicare pays for one flu vaccination per flu season; however, a beneficiary could receive the flu vaccine twice in a calendar
vaccination must accept assignment on the claims for the vaccine.
year for two different flu seasons and the provider would be reimbursed for each. For example, a beneficiary could receive a flu
vaccination in January 2009 for the 2008-2009 flu season and another flu vaccination in November 2009 for the 2009-2010 flu season
• Influenza virus, pneumococcal, and hepatitis B vaccinations
and Medicare would pay for both vaccinations.
and their administration are covered Part B benefits and are NOT
covered Part D benefits.
Will Medicare pay for the pneumococcal vaccination if a beneficiary is uncertain of his or her vaccination history?
Yes. If a beneficiary is uncertain about his or her vaccination history in the past 5 years, the vaccine should be given and Medicare
will cover the revaccination. If a beneficiary is certain that more than 5 years have passed, revaccination is not appropriate unless
the beneficiary is at highest risk.
resources
The Guide to Medicare Preventive Services for Physicians,
Does Medicare cover the hepatitis B vaccine for all Medicare beneficiaries?
Providers, Suppliers, and Other Health Care Professionals
No. Medicare provides coverage for certain beneficiaries at intermediate to high risk for the hepatitis B virus (HBV). These individuals
http://www.cms.hhs.gov/MLNProducts/downloads/mps_guide_
include workers in health care professions who have frequent contact with blood or blood-derived body fluids during routine work,
web-061305.pdf
those with End Stage Renal Disease (ESRD), and persons who live in the same household as an HBV carrier. There are other
situations which could qualify a beneficiary as being at intermediate or high risk of contracting HBV.
Influenza (Flu) Season Educational Products and Resources
http://www.cms.hhs.gov/MLNProducts/Downloads/flu_products.pdf
When a beneficiary receives both the influenza virus and pneumococcal vaccines on the same visit, would a provider continue to
report separate administration codes for each type of vaccine?
CMS Website Adult Immunization Web Page
Yes. Although the provider would use diagnosis code V06.6 when an individual receives both vaccines, separate administration codes
http://www.cms.hhs.gov/AdultImmunizations/
for the influenza virus (G0008) and pneumococcal (G0009) vaccines should be reported. Medicare will pay both administration fees if
a beneficiary receives both the influenza virus and the pneumococcal vaccine on the same day.
Medicare Claims Processing Manual –
Chapter 18, Preventive and Screening Services
Can the influenza virus, pneumococcal, and hepatitis B vaccinations all be roster billed?
http://www.cms.hhs.gov/manuals/downloads/clm104c18.pdf
No. Only the influenza virus and pneumococcal vaccines are eligible for roster billing. Roster billing does not apply to the hepatitis
Medicare Benefit Policy Manual –
B vaccine.
Chapter 15, Section 50.4.4.2 - Immunizations
http://www.cms.hhs.gov/manuals/downloads/bp102c15.pdf
What is a mass immunizer?
A mass immunizer offers flu and/or pneumococcal vaccinations to a large number of individuals and may be a traditional Medicare
Medicare Preventive Services Adult Immunizations Brochure
provider or supplier or a nontraditional provider or supplier (such as a senior citizen’s center, a public health clinic, or community
http://www.cms.hhs.gov/MLNProducts/downloads/Adult_
pharmacy). Mass immunizers must submit claims for immunizations on roster bills and must take assignment on both the vaccine
Immunization.pdf
and its administration. A mass immunizer should enroll with the FI, carrier, or Part A/B Medicare Administrative Contractor (A/B MAC)
prior to flu season. Please see the next question for more enrollment information.
CDC Vaccines & Immunizations
http://www.cdc.gov/vaccines/default.htm
Do providers that only provide immunizations need to enroll in the Medicare Program?
Yes. Providers must enroll in the Medicare Program even if immunizations are the only service they will provide to beneficiaries.
For beneficiary-related information
They should enroll as provider specialty type 73, Mass Immunization Roster Biller by completing Form CMS-855I for individuals
http://www.medicare.gov
or Form CMS-855B for a group. Visit http://www.cms.hhs.gov/MedicareProviderSupEnroll/ to locate these forms. Providers
1-800-MEDICARE (1-800-633-4227)
who do not provide other covered services to Medicare beneficiaries complete only the portion of the enrollment form that
TTY users (1-800-486-2048)
applies to mass immunizers. New providers must also first receive a National Provider Identifier (NPI) prior to enrollment. Visit
https://nppes.cms.hhs.gov for NPI enrollment information.
The Medicare Learning Network (MLN) is the brand name for
official CMS educational products and information for Medicare
May a single claim form be submitted containing information for both the pneumococcal and influenza virus vaccinations when the
fee-for-service providers. For additional information visit the
vaccinations are administered on the same visit and roster billed?
Medicare Learning Network’s web page at
http://www.cms.hhs.gov/MLNGenInfo on the CMS website.
No. Separate CMS claims must be used for each vaccine. Each claim must have an attached roster bill listing the beneficiaries who
received that type of vaccination.
This quick reference information was prepared as a service to the public and is not intended to grant rights or impose obligations. This quick reference information may contain references or links to statutes, regulations, or other policy
materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other
interpretive materials for a full and accurate statement of their contents.
CPT is a registered trademark of the American Medical Association (AMA). Applicable FARS/DFARS Restrictions Apply to Government Use. Fee schedules, relative value units, conversion factors and/or related components are not assigned by
the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.
The International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) is published by the United States Government. A CD-ROM, which may be purchased through the Government Printing Office, is the only official
Federal government version of the ICD-9-CM. ICD-9-CM is an official Health Insurance Portability and Accountability Act standard.
march 2009
ICN: 006799
