Preventive Services

Published 12/21/2022

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

Resource: CMS MLN Medicare Part D Vaccines Fact Sheet.

Last Reviewed: 12/21/2022

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: 12/21/2022

No. Railroad Medicare does not cover TDAP CPT® code 90715, even though it includes the tetanus component, due to the additional preventive component of the acellular pertussis vaccine for whooping cough.

Medicare Part D plans generally cover all commercially available vaccines as long as the vaccine is reasonable and necessary to prevent illness. Contact the patient’s Medicare Part D plan to verify their coverage of the TDAP vaccine.

Last Reviewed: 12/21/2022

Yes. Railroad Medicare covers CPT® code 90714 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: 12/21/2022

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: 12/21/2022

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

Resources

Last Reviewed: 12/21/2022

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: 12/21/2022

The Centers for Medicare & Medicaid Services (CMS) offers many resources to assist you when billing for these services including:
  • CMS MLN Medicare Preventive Services Educational Tool — includes codes, who is covered, frequency, and what the beneficiary pays
  • CMS IOM Pub. 100-02, Medicare Benefit Policy Manual, Chapter 15, Section 280.3 (PDF)
  • CMS IOM Pub. 100-04, Medicare Claims Processing Manual, Chapter 18, Section 20 (PDF)

Last Reviewed: 12/21/2022

The Centers for Medicare & Medicaid Services (CMS) offers many resources to assist you when billing for these services including:
  • CMS MLN Medicare Preventive Services Educational Tool — includes codes, who is covered, frequency, and what the beneficiary pays 
  • CMS MLN Screening Pap Tests and Pelvic Examinations Booklet 
  • CMS IOM Pub. 100-02, Medicare Benefit Policy Manual, Chapter 15, Section 280.4 (PDF)
  • CMS IOM Pub. 100-04, Medicare Claims Processing Manual, Chapter 18, Section 30 and 40 (PDF)

Last Reviewed: 12/21/2022


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