November 6, 2018
Coverage of Vaccines: Part B vs. Part D
As your Part B Medicare Administrative Contractor (MAC), CGS processes claims for vaccines covered under the Part B benefit. The Part B program covers most of the vaccines directed for the Medicare population, with the prescriber administering the vaccine and billing the Part B contractor for both the vaccine and its associated administration.
Covered Under Part B? | Is the Administration Covered? | |
---|---|---|
Influenza Virus Vaccine | YES | YES |
Pneumococcal Pneumonia Vaccine | YES | YES |
Hepatitis B Vaccine | YES – For intermediate and high risk patients | YES |
NO – For no/low-risk patients (refer to patient's Medicare Part D plan) | NO – Check with patient's Medicare Part D plan | |
Tetanus Toxoid | YES – To treat an injury or illness | YES |
NO – Absence of injury or illness (refer to patient's Medicare Part D plan) | NO – Check with patient's Medicare Part D |
Please keep in mind, in all situations; Medicare Part B does not cover the administration of vaccines not covered under the Part B Benefit. Please contact the patient's Part D plan regarding coverage of additional drugs and administration.
For additional information on Part B and Part D vaccines and its administration, please reference the following:
- Part B Medicare Preventive Services
- Medicare Part D Vaccines and Vaccine Administration MLN Fact Sheet
- MLN Matters® Article SE0678: Payment for Part D Vaccines under the Medicare Drug Benefit (Part D)
- MLN Matters® Article SE0727: Reimbursement for Vaccines and Vaccine Administration Under Medicare Part D