41 st National Immunization Conference March 5 – 8, 2007 Kansas City, Missouri Medicare Coverage for Influenza & Pneumococcal Immunizations Presented by: Debra Brigham Coverage Policy Specialist

Immunization Partnership Medicare beneficiaries Centers for Medicare & Medicaid Services Centers for Medicare & Medicaid Services Centers for Disease Control, Immunization Coalitions and other providers nation wide. Coalitions and other providers nation wide. Medicare Contractors & Coalitions nation wide Medicare Contractors & Coalitions nation wide

Influenza Virus Vaccine Medicare pays for influenza vaccines and the administration. Generally, only one influenza virus vaccination is medically necessary per year. Beneficiaries may receive the vaccine once each flu season without a physician’s order and without the supervision of a physician.

Mandatory Claims Filing The Social Security Act requires that providers bill Medicare for covered Part B services rendered to eligible beneficiaries. Public health clinics and others must bill Medicare for the vaccine and its administration when provided to Medicare beneficiaries.

Simplified Billing Process Generally, providers will qualify to use the simplified process if they: –Bill Medicare for influenza virus vaccines and/or PPVs for multiple beneficiaries; and, –Agree to accept assignment for influenza vaccination and/or PPV claims.

Simplified Billing Process The roster should not be used for single-patient bills. Dates of service for each vaccination and administration must be entered. Providers who do not qualify to use the simplified process must complete a standard CMS-1500 claim form or bill electronically for each Medicare beneficiary receiving the vaccine.

Simplified Billing Process Medicare will issue a provider number for those providers who qualify for simplified billing procedures for influenza and/or PPV claims and who do not have a Medicare provider number. Physicians may use their current provider number for roster billing.

Provider Enrollment To obtain a Medicare provider number: –( Effective May 23, 2007, providers will be required to enter their 10- digit National Provider Identifier (NPI) – Download the 855B Provider Enrollment application from your local Carrier website or the CMS website:

Pre-printed Claim Forms May be used to bill: – Influenza or – PPV vaccine on roster forms

Pre-printed Claim Forms Requirements for Pre-printed CMS-1500 claim form –Providers are required to complete: item 21 - diagnosis code item 24B - place of service item 24D - appropriate code procedure code item 24f - charge per dose item 25 - federal tax id number item 31 - physician signature/authorized person item 32 - name & complete address including zip code of the facility where services are rendered. item 33 - provider’s name, address & provider number

Electronic Roster Billing Free or low cost software package –Influenza/Pneumococcal Roster Billing (I/PRB) Call the Technology Support Center for your local Medicare Contractor

Incentives for Electronic Filing Your electronic claims may be paid after only 14 days Paper claims are paid after 28 days

Flu Vaccine Reimbursement for 2007 Flu Season Flu vaccine codes ( ), providers must submit the claim with a diagnosis of V Flu vaccine preservative 6-35 mo $ Flu vaccine no preservative 3 yrs & >$ Flu vaccine 3 years, im $ Flu vaccine 3 years & >, im $ Flu virus vaccine, live, intranasal use $ (limited coverage for label use of age 5 -49) Pneumococcal (PPV) code 90732, providers must submit the claims with diagnosis of V PPV$27.03 When the purpose of the visit is for both vaccines the diagnosis V066 should be submitted on the claim.

Administration Reimbursement HCPCS code G0008 should be reported for the administration of the influenza virus vaccine. HCPCS code G0009 should be reported for the administration of PPV. Allowed amounts for administrations are based on the locality of the where the services are rendered.

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See Medicare Publications in your state for fee Updates usually 10/01/XX & 01/01/XX Medicare Part B Medicare Newsletter Publications

Open Discussion Any questions or comments?

for attending this presentation Thank You!