Wiki Tdap and Medicare

[EMCordone]

I just got a call from a patient saying that the Tdap vaccine was now covered by Medicare. I know this is true for pharmacies, but has that also changed for medical offices? I've been submitting Tdap claims to Medicare having the patient sign and ABN and I have yet to see Medicare pay for one. Anybody able to help with this?

 

[jreich3]

Tdap

"CDPH received clarification on coverage of the pertussis booster vaccine (Tdap) from
the Centers for Medicare and Medicaid Services (CMS) regarding coverage of Tdap
immunization for beneficiaries. Tdap vaccine is a Part D covered drug for use in
patients 65 years of age and older. Tdap vaccine may be obtained by Medicare Part D
beneficiaries from a network pharmacy without out-of-pocket costs by the beneficiary.
Tdap may also be provided in a network provider's office; however, this would require
the beneficiary to pay for the vaccine costs up front and then be reimbursed by their
Medicare Part D plan. The beneficiary should contact their Medicare Part D plan in
advance for detailed instructions on reimbursement for Tdap vaccination."


"CMS reminds Part D sponsors that the Tdap vaccine is a Part D covered drug and is on-compendia for use in patients 65 and older. The Tdap vaccine may be obtained from a network pharmacy and administered by a pharmacist registered for vaccine administration or in a network provider's office. This will benefit members by providing a choice in access and administration to the vaccine."

 

[DavaAdams]

tdap w Medicare

You do have the option of signing up for an eDispense account and bill the patients Part D for the tdap and administration.