Home Health & Hospice

Influenza Vaccination a Covered Medicare Benefit

Homecare Insider, October 31, 2011

The influenza vaccine plus its administration are covered Medicare Part B benefits. It’s important to note that the influenza vaccine is not a Part D covered drug. The Centers for Medicare and Medicaid Services (CMS) has posted the 2011-2012 seasonal influenza vaccine payment limits.

For homecare providers, if the sole purpose for a visit is to administer a vaccine, Medicare will not pay for a skilled nursing visit, but the vaccine and its administration are covered under the vaccine benefit. The administration should include the supplies being used and the cost of the injection; agencies are not allowed to charge for travel time or other expenses.

If the vaccine is administered during an otherwise covered skilled nursing visit, the visit would be covered as normal, but the agency would not include the vaccine or its administration in their visit charge. In this case, both the vaccine and its administration would be covered by the vaccine benefit. In this situation, the agency would bill under bill type 34x and report revenue code 0636 along with the appropriate HCPCS code for the vaccine and revenue code 0771 along with the appropriate HCPCS code for the administration.

Check out CMS’ educational resources regarding Medicare’s preventative services today!