Preventive Services

Published 09/18/2024

No, providers may not bill Medicare Part B for administering Part D vaccines.

Resource: CMS MLN Medicare Part D Vaccines Fact Sheet.

Last Reviewed: 9/18/2024

No, shingles vaccines are not covered under Part B Medicare. The shingles (herpes zoster) vaccine is a preventive vaccine that can be covered by Part D Medicare. Contact the patient’s Medicare Part D plan to verify their coverage of the shingles vaccine.

Last Reviewed: 9/18/2024

Yes. Railroad Medicare covers CPT® code 90714 and CPT® code 90715 for tetanus antitoxin or booster vaccines when the vaccine is directly related to the treatment of an injury or direct exposure to a disease or condition. Medicare does not cover routine tetanus booster shots in the absence of injury or direct exposure.

Last Reviewed: 9/18/2024

Table 1. Preventive Immunization.
Preventive Immunization HCPCS Code
Influenza Virus Vaccine G0008
Pneumococcal Vaccine G0009
Hepatitis B Vaccine G0010

CPT® codes 90471 and 90472 will be denied when billed as the administration code for a preventive immunization that has been assigned a specific administration code.

For more information on billing preventive immunizations, see the CMS Medicare Preventive Services Tool.

Last Reviewed: 9/18/2024

Medicare Part B covers the following immunizations:
  • Hepatitis B vaccine (for patients at high or intermediate risk)
  • Influenza virus vaccine
  • Pneumococcal pneumonia vaccine
  • COVID-19 vaccine
  • Vaccines directly related to the treatment of an injury or direct exposure to a disease or condition

Resources

Last Reviewed: 9/18/2024

Except for vaccines covered under Medicare Part B, Medicare Part D plans generally cover all commercially available vaccines as long as the vaccine is reasonable and necessary to prevent illness. This includes preventive shingles (herpes zoster) vaccines and TDAP vaccines.

Part D plans may have special rules, such as prior authorization, step therapy and quantity limits. Contact your patient’s plan to find out about coverage.

Resource: CMS MLN Medicare Part D Vaccines Fact Sheet.

Last Reviewed: 9/18/2024

The CMS MLN Medicare Preventive Services Educational Tool includes coding, coverage, frequency, and what the beneficiary pays for Medicare covered preventive services.

Last Reviewed: 9/18/2024


Was this article helpful?