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Pulmonology Coding Alert

Reader Question:

Discuss ABN with your patient before pertussis vaccination

Published on Wed Jan 19, 2011

Question: Our facility administered Tdap vaccine to a few Medicare patients. These patients did not sign an ABN. Is the vaccine covered under Part B or Part D? If this is a Part D immunization, how can our office get reimbursed from the patients who have been administered the vaccine?New York SubscriberAnswer: CMS classifies all vaccinations under Part B or Part D. Medicare Part B provides vaccine reimbursement for Medicare patients when it is termed as medically necessary. Medicare Part B does not provide any reimbursement for vaccines that are classified under Part D.Tdap vaccine is a vaccine that is provided for the prevention of pertussis (whooping cough). This is a vaccine that comes under Part D, and it should be obtained by a Medicare Part D network pharmacy without out-of-pocket costs by the beneficiary. It may also be provided in a network provider's office; however, this would require the beneficiary [...]
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