New Coverage Updates for Pneumococcal Vaccinations

New Coverage Updates for Pneumococcal Vaccinations

Prior to 2015, pneumococcal vaccine was covered once in a beneficiary’s lifetime, with revaccinations covered for those at highest risk if 5 years have passed since the last vaccination or if the beneficiary’s vaccination history was unknown. The Advisory Committee on Immunization Practices (ACIP) recently updated its guidelines regarding pneumococcal vaccines. The ACIP recommends administration…

Influenza Vaccine Payment rates

Influenza Vaccine Payment rates

CR 8433 provides payment allowances for the following seasonal influenza virus vaccine codes when payment is based on 95 percent of the AWP, except when furnished in a hospital outpatient department, a Rural Health Clinic, or a Federally Qualified Health Center for which payment is based on reasonable cost: • Current Procedural Terminology (CPT) codes…

Replacement Code For CPT 90718

Replacement Code For CPT 90718

The replacement code for CPT 90718 is 90714. MM4222 alerts Medicare carriers and intermediaries that Effective July 1, 2005 they must use the new Current Procedural Terminology (CPT) 90714 CPT Code (Tetanus and diphtheria toxoids (Td) adsorbed, preservative free, for use in individuals seven years or older, for intramuscular use) for services previously billed under CPT Code…

Payments for Influenza vaccine CPT codes

Payments for Influenza vaccine CPT codes

Medicare provides coverage for one seasonal influenza virus vaccine per influenza season for all Medicare beneficiaries. Medicare generally provides coverage of pneumococcal vaccination and its administration once in a lifetime for all Medicare beneficiaries. Medicare may provide coverage of additional pneumococcal vaccinations based on risk or uncertainty of beneficiary pneumococcal vaccination status. Medicare provides coverage…

Administration Code for Hepatitis B – New Updates

Administration Code for Hepatitis B – New Updates

CPT G0010 Administration of hepatitis B vaccineThe Centers for Medicare & Medicaid Services (CMS) retroactively assigned HCPCS code G0010 to APC 0436, Level I, Drug Administration,and changed the status indicator for HCPCS code CPT G0010 from status indicator “B” to status indicator “S” effective January 1, 2011.Effective for claims processed with dates of service on…

Medicare Non-covered vaccine CPT code list

Medicare Non-covered vaccine CPT code list

With the exception of vaccinations for pneumococcal pneumonia, hepatitis B, and influenza, which are specifically covered under the law, vaccinations or inoculations are generally excluded as immunizations unless, they are directly related to the treatment of an injury or direct exposure such as antirabies treatment, tetanus antitoxin or booster vaccine, botulin antitoxin, antivenin, or immune…

Roster Billing

Roster Billing

Roster Billing is a simplified billing process that allows mass immunizers to submit one claim with a list of the members they immunized. Mass immunizers must meet Original Medicare requirements in order to use the roster billing method. Mass immunizers A mass immunizer is defined as any entity that gives the influenza virus vaccine or…