Influenza and Pneumonia Vaccinations in the Home Health or Hospice Setting
During the current public health emergency for COVID-19, it is especially important to ensure that all patients are up to date with their influenza and pneumonia vaccinations.
Home health agencies can provide the influenza virus vaccine and pneumococcal pneumonia vaccination (PPV) and they are billed on a 341 type of bill (home health outpatient Part B benefit).
Hospice agencies can provide the influenza virus and pneumococcal vaccinations to beneficiaries who request them, including those who have elected the hospice benefit. These services may be covered when furnished by the hospice agency for dates of service on or after October 1, 2016. Vaccinations provided by a hospice agency may be billed on an institutional claim to the Medicare contractor. Since these services are not part of the Medicare hospice benefit, they must be billed on a separate claim and must only include charges for the vaccine and their administration.
For further information regarding the influenza and pneumonia vaccinations, please review the following materials from CMS:
- Increasing Flu Shot Outreach & Uptake
- Flu Vaccine Partner Toolkit
- Flu Shot Payment Rates for 2020 - 2021
- Seasonal Influenza Vaccines Pricing
- Centers for Medicare & Medicaid Services (CMS) Internet-Only Manual (IOM) Publication 100-02, Medicare Benefit Policy Manual, Chapter 15, Section 22.214.171.124, Immunizations (PDF, 1.29 MB)
- CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 18, Section 10.2.3 (PDF, 1.22 MB)
- MLN Influenza Vaccine Payment Allowances – Annual Update for 2020 2021 Season (PDF, 179 KB)