Part B Insider (Multispecialty) Coding Alert

Published on Tue Jul 24, 2007 PDF

Don't waste your time billing Part D plans

Heads up: You won't be able to bill Medicare Part B for administering the herpes zoster (shingles) vaccine and other vaccines next year.

Medicare plans to delete vaccine administration code G0377 on Jan. 1, according to MLN Matters articles SE0723 and SE0727. This year, you can use that code to bill for administering vaccines that Medicare Part D pays for.

But starting next year, you-ll have to bill the patient directly for both the vaccine and its administration, -and the patient will need to submit the claim to their Part D plan for reimbursement,- according to MLN Matters article SE0723.

But MLN Matters article SE0727 also says that providers -should contact Part D plans regarding specific vaccine administration fees for 2008---which suggests that you could bill the Part D plan directly, instead of billing the patient.

It's the law: Congress required this change in the Medicare reform bill it passed in late 2006. That law says that both vaccines and their administration should be covered by Part D, not Part B. This policy doesn't apply to vaccines that Part B covers, the article notes.

Operational nightmare: Different Part D plans may have their own rules about whether, or how, they-ll pay for vaccine administration, notes LuAnn Weis, compliance specialist with Hackensack University Medical Center in Hackensack, NJ. Trying to collect money from each plan  could be an -operational nightmare.-

So it makes sense to collect money from the patient up front and then allow the patient to bill the Part D plan, Weis notes.

If Medicare definitely won't pay for the vaccine administration in 2008, then you won't need to ask the patient to sign an Advance Beneficiary Notice (ABN), notes Maxine Lewis with Medical Reimbursement Management in Cincinnati. Some Medicare secondary insurers may pay for the vaccine administration, she adds.

But it may still make sense to obtain a signed ABN, just so the patient is clear that Medicare won't pay for the administration, says Pat Larabee, coding specialist with Intermed in South Portland, ME.

Note: Part B still covers vaccines for pneumococcal pneumonia, influenza virus and, for high-risk individuals, hepatitis B. Part B  may also cover other vaccines,  such as tetanus, when a patient has an injury or exposure to a disease  or condition.

(Note: You can read both MLN Matters articles by going to www.cms.hhs.gov/MLNMattersArticles/.)