Vaccinations

Part B Medicare provides coverage for specific vaccination types:

• Seasonal Influenza Virus
• Pneumococcal
• Hepatitis B
• COVID-19 Vaccines and Administration

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Seasonal Influenza Virus

Annual Influenza Vaccine season starts August 1 and ends July 31 of the following year.

Payment Allowances and Effective Dates for the 2024-2025 Flu Season

For the most up to date list of billing codes, payment allowances and effective dates for the 2024-2025 flu season, please see Seasonal Influenza Vaccines Pricing.

For influenza virus vaccination, the following ICD-10 diagnosis codes apply:

• Z23

Additional ICD-10 codes may apply. See CMS ICD-10 webpage for individual CRs and the specific ICD-10-CM codes Medicare covers for this service.

Influenza Vaccination: Who is Covered/Frequency

• All Medicare beneficiaries
• Once per influenza season (Medicare covers additional flu shots in medically necessary)

Influenza Vaccination: Other Notes

• Copayment, coinsurance, deductible waived
• As a reminder, please review and use the appropriate flu vaccine code to avoid processing delays and claim denials on the CMS Seasonal Influenza Vaccines Pricing web page.
• Pricing information for the G0008 administration code is located on the Vaccines and Administration Pricing section on the Fee Schedule Lookup web page.
• Effective 1/1/2024 Medicare pays an additional payment for in-home flu shot administration under certain circumstances.
  • In-Home Vaccine Administration: Additional Payment

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Pneumococcal

For pneumococcal vaccination, the following procedure codes apply:

For pneumococcal vaccination, the following ICD-10 diagnosis codes apply:

• Z23
• Additional ICD-10 codes may apply. See CMS ICD-10 webpage for individual CRs and the specific ICD-10-CM codes Medicare covers for this service.

Pneumococcal Vaccination: Who is Covered/Frequency

• All Medicare beneficiaries
• An initial pneumococcal vaccine to Medicare beneficiaries who never received the vaccine under Medicare Part B
• A different, second pneumococcal vaccine one year after the first vaccine was administered
• Visit CDC’s Pneumococcal Vaccine Timing for Adults 

Pneumococcal Vaccination: Other Notes

• Copayment, coinsurance, deductible waived
• Additional information on specific shots and administration timing to align with the Advisory Committee on Immunization Practices recommendations: MLN Matters^® MM12723 Revised: Revisions to Medicare Part B Coverage of Pneumococcal Vaccinations for the Medicare Benefit Policy Manual Chapter 15, Section 50.4.4.2
• Starting 1/1/2024 Medicare pays an additional payment for in-home PPV shot administration under certain circumstances.
  • In-Home Vaccine Administration: Additional Payment

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Hepatitis B

For HBV vaccinations, the following procedure codes apply:

For HBV vaccinations, the following ICD-10 diagnosis codes apply:

• Z23

Additional ICD-10 codes may apply. See CMS ICD-10 webpage for individual CRs and the specific ICD-10-CM codes Medicare covers for this service.

HBV Vaccination: Who is Covered/Frequency

• Certain Medicare beneficiaries at intermediate or high risk for contracting hepatitis B. Intermediate and high risk is defined in the CMS IOM Publication 100-02, Medicare Benefit Policy Manual, Chapter 15, Section 50.4.4.2 – Immunizations
• Medicare beneficiaries who are currently positive for antibodies for hepatitis B are not eligible for this benefit
• Scheduled doses required

HBV Vaccination: Other Notes

• Copayment, coinsurance, deductible waived
• Effective 1/1/2024 Medicare pays an additional payment for in-home HBV shot administration under certain circumstances.
  • In-Home Vaccine Administration: Additional Payment

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COVID-19 Vaccines and Administration

The claim should include the proper billing of the ICD-10. Providers can submit claims using the following example:

• ICD-10: Z23 - Encounter for immunization
• Report the proper date of service
• Report the proper place of service (for Part B claims)
• Get the most current list of billing codes, payment allowances and effective dates at COVID-19 Vaccines and Monoclonal Antibodies
• Medicare pays an additional payment for in-home COVID-19 shot administration under certain circumstances.
  • In-Home Vaccine Administration: Additional Payment

Related Content

• CMS IOM Publication 100-02, Medicare Benefit Policy Manual, Chapter 15, Section 50.4.4.2 – Immunizations
• CMS Preventive Services
• MLN^® Educational Tool: Medicare Preventive Services
• Fee Schedule Lookup Tool

Revised 10/16/2024