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Posts Tagged ‘preventative’

Vaccine Coverage Reminder… What Do Medicare Preventative Services Cover?

In Uncategorized on August 22, 2013 at 9:03 pm

MEDIC wants to remind its providers that the following vaccines are the only ones that are automatically covered under Medicare’s preventative services:

  • The flu vaccine is covered on an annual basis,
  • The pneumococcal vaccine is covered once per lifetime, and
  • The hepatitis-B vaccine is covered in the event that a patient is deemed/falls into a high risk category

Other vaccines are covered only based on patient exposure.  Examples of vaccines that receive coverage based on exposure are: tetanus, rabies, botulin, antivenin or immune globulin.  For any of these exposure-based vaccines, providers should have patients complete an ABN (Advanced Beneficiary Notice – see http://www.cms.gov/Medicare/Medicare-General-Information/BNI/ABN.html — at the bottom of the page, there are downloads from which you can   access the current ABN) to ensure collection of monies for these otherwise routine vaccines. 

In speaking with billing staff, we have deduced that the majority of patient calls/questions are regarding the tetanus vaccine, so to reiterate:  if a patient suffers an injury, then Medicare will cover the tetanus vaccine; however, absent an injury (i.e., a routine administration), that vaccine will not be covered.

Finally, please note that the Zoster vaccine for shingles is a Medicare Part B non-covered service, which will require an ABN in order to be able to bill the patient.  Patients may have Part D coverage or a secondary that will cover it, but that is a case-by-case coverage analysis, and not necessarily the norm.  

 Please feel free to contact MEDIC if you have any questions relating to this issue of vaccine coverage.

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