2009-09-10

A new Special Edition MLN Matters article regarding Billing for the Administration of the Influenza A (H1N1) Vaccine is now available. This article explains Medicare coverage and reimbursement rules for the H1N1 vaccine and also addresses seasonal flu coverage and reimbursement. 

Note that Medicare will pay for seasonal flu vaccinations even if the vaccinations are rendered earlier in the year than normal. We understand that such preparations are critical for the upcoming flu season, especially in planning for the influenza A (H1N1) vaccine.

Though Medicare typically pays for one vaccination per year, if more than one vaccination per year is medically necessary (i.e., the number of doses of a vaccine and/or type of influenza vaccine), then Medicare will pay for those additional vaccinations. Our Medicare claims processing contractors have been notified to expect and prepare for earlier-than-usual seasonal flu claims and there should not be a problem in getting those claims paid. Furthermore, in the event that it is necessary for Medicare beneficiaries to receive both a seasonal flu vaccination and an influenza A (H1N1) vaccination, then Medicare will pay for both.

Please be advised that if either vaccine is provided free of charge to the health-care provider, then Medicare will only pay for the vaccine’s administration (not for the vaccine itself).

All providers administering flu vaccine should review this article and be sure that their billing staffs are aware of this information.

In addition, the Centers for Medicare & Medicaid Services has updated its Medicare Fee-for-Service Emergency Preparedness Questions and Answers (Qs & As). These Qs & As include a section applicable to the H1N1 flu virus.

Additional information from the Centers for Disease Control & Prevention about the H1N1 virus is available on the Emergency Preparedness section of the ASH Web site.

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