Influenza, pneumococcal, and hepatitis B (intermediate or high risk, 126.96.36.199) may all be preventative vaccines, but the vaccine and its administration are covered 100% by Medicare Part B regardless of where the service is furnished. This includes coverage under Part B when administered to an inpatient during a hospital stay covered under Medicare Part A.
We call this out and dedicate this newsletter for two main reasons:
Medicare only covers select preventative services. Traditionally, immunizations are only covered when used for treatment of an injury or direct exposure, such as rabies vaccine (see previous newsletter).
Coverage regardless of location is provided by Medicare Part B (only)!
In review of the basics, select billing codes should be applied to each claim when billing for influenza, pneumococcal, and hepatitis B.
✅ Vaccine HCPCS
These vary by product and should reference addendum B or HCPCS – NDC crosswalks
✅ Vaccine administration code
G0008 – Administration of influenza virus vaccine
G0009 – Administration of pneumococcal vaccine
G0010 – Administration of hepatitis B vaccine
Note these HCPCS codes may be replaced with an alternative HCPCS, such as 90471, for other payers.
✅ Diagnosis code – Z23 (used for all 3 vaccines)
✅ Revenue code 0636 Vaccine codes
✅ Revenue code 0771 Administration codes
To ensure payment is made, a bill must be submitted to Part B even when the patient is admitted to an inpatient unit. Here is the catch! The vaccine and administration codes cannot be placed on the inpatient claim! Billing for influenza, pneumococcal or hepatitis B vaccines and the administration must be split from the inpatient claim and billed on a type of bill 012x to represent Hospital Inpatient Part B.
Shout Outs! Revenue integrity and pharmacy/nursing teams – ensure administration charges are being billed each time, regardless of location, for each influenza, pneumococcal and hepatitis B vaccine.
Billing teams – review claims logic and ensure when any HCPCS that represent influenza, pneumococcal and hepatitis B are utilized in an inpatient setting, these claims split these codes to a 012x type of bill.