The payment allowance is established nationally as 95% of the average wholesale price, and are updated quarterly based on published average wholesale price data.
The administration code for the pneumococcal vaccine is G0009.
Medicare follows the Centers for Disease Control (CDC) recommendations, since there are differing factors for those at certain ages and/or with certain underlying medical conditions or other risk factors. View the CDC’s Pneumococcal Vaccine Timing for Adults for their recommendations.
No. A roster bill should consist of one type of vaccine and administration code on the entire bill. If you administer two different vaccines at a mass immunization site, e.g., the influenza and pneumococcal vaccines, they need to be on separate roster bills.
No, the coinsurance and deductible do not apply to the pneumococcal vaccine.
No, Medicare does not require an order for the vaccine. The Medicare beneficiary may receive the vaccine upon request without an order.
No, Medicare does not pay solely for counseling and education of the pneumococcal vaccine. However, if Medicare-covered services are provided during the visit in which the immunization is given, providers may bill for those other medically necessary services, including evaluation and management services.
Yes, two administration fees may be paid if the patient received two immunizations during the same encounter.