Re: medicare pricing on vaccines

[Guest guest]

Flu and Pneumococcal

90732 $27.03 G0009 V03.82

90660 $21.18 G0008 V04.81

90658 $12.62 G0008 V04.81

90656 $16.57 G0008 V04.81

Code Allowable Administration ICD-9-CM

Flu and Pneumonia on the same day

V06.6 instead of V04.81 and V03.82

http://www.mmgma.com/programs/ri_prez07/Medicare.pdf

slide 11

Guinn wrote:

>

> I'm looking for a list of 2007 Medicare allowables for all the

> vaccines they cover.

> I've already got the Medicare fee schedule, I've found the HCPCS

> list, but those codes are not in there (90732, 90658, etc)

> Anyone know where they are?

> I'm in New Mexico, know eveything has a regional variation, but not

> certain that's the case with vaccines.

> Thanks,

>

>

>

> ------------------------------------------------------------------------

>

> No virus found in this incoming message.

> Checked by AVG Free Edition.

> Version: 7.5.503 / Virus Database: 269.16.15/1174 - Release Date: 12/6/2007

10:11 AM

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[Guest guest]

And Hep B only if it is "indicated" not for routine vaccination.

Horses mouth...

http://www.cms.hhs.gov/AdultImmunizations/

Overview

Approximately 50,000 adults die each year from vaccine-preventable diseases in the U.S. Pneumonia and influenza are the fifth leading cause of death in older adults in the U.S. According to the Centers for Disease Control and Prevention (CDC), 1.25 million people are infected with the hepatitis B virus, which attacks the liver and can cause liver cancer, liver failure, and death.

The Adult Immunization section provides information and resources related to the coverage, billing, delivery, and promotion of influenza, pneumococcal, and hepatitis B vaccinations. Medicare covers both the costs of these vaccines and their administration by recognized providers. The following sections address influenza and pneumococcal vaccinations together because of the similarities in their coverage and billing policies. Hepatitis B vaccination is addressed separately.

This page provides general facts about adult immunization and links to other resources. These resources include a brochure which can be downloaded and used in efforts to promote adult immunization.

General Facts:

Influenza, also called the "flu," is a contagious respiratory illness caused by influenza viruses. There are over 200,000 hospitalizations from influenza on average every year. An average of 36,000 Americans die annually due to influenza and its complications – most are people 65 years of age and over. The best way to prevent the flu is to get vaccinated each year during the fall season. Because flu viruses change from year to year, it is important to get a flu shot each year. Medicare pays for the influenza immunization or "flu shot." The links below provide general information related to influenza vaccinations.

Pneumococcal pneumonia is the most common type of bacterial pneumonia. There are over 40,000 cases of invasive pneumococcal disease in the U.S. and approximately one-third of these cases occur in people 65 and older. Over half of the more than 5,000 annual deaths from invasive pneumococcal disease occur in persons 65 years of age and older. Medicare covers one pneumococcal vaccination for all Medicare beneficiaries. One vaccine at age 65 generally provides coverage for a lifetime, but for some high risk persons, a booster vaccine is needed. Medicare will also cover a booster vaccine for high risk persons if 5 years have passed since their last vaccination. The links below provide general information related to pneumococcal vaccinations.

Hepatitis B virus can cause serious liver disease, including cirrhosis, liver cancer, liver failure, and death. The virus is found in the blood and body fluids of infected people and can be spread through sexual contact or the sharing of needles. The hepatitis B vaccination can protect high risk persons, such as people with renal disease or hemophilia, from contracting the disease. The vaccine is delivered in a series of 3 shots. Medicare pays for hepatitis B vaccination for people considered to be at high risk for the disease.

What Medicare covers?

Influenza Immunizations: Medicare began covering annual influenza immunizations in 1993 for all Medicare beneficiaries. Medicare covers both the costs of the vaccine and its administration by recognized providers. There is no coinsurance or co-payment applied to this benefit, and a beneficiary does not have to meet his or her deductible to receive this benefit.

Pneumococcal Polysaccharide Vaccinations: Medicare began covering pneumococcal polysaccharide vaccinations in 1981. Medicare provides coverage for 1 pneumococcal polysaccharide vaccine for all beneficiaries. One vaccine at age 65 generally provides coverage for a lifetime, but for some high risk persons, a booster vaccine is needed. Medicare will also cover a booster vaccine for high risk persons if 5 years have passed since the last vaccination. Medicare covers both the costs of the vaccine and its administration by recognized providers. There is no coinsurance or co-payment applied to this benefit, and a beneficiary does not have to meet his or her deductible to receive this benefit.

Hepatitis B Vaccinations: Medicare began covering hepatitis B vaccinations in 1984. Persons at high or intermediate risk, such as people with renal disease or hemophilia, homosexual men, and clients of institutions for the mentally handicapped are among those who are eligible to receive this benefit. Medicare covers both the costs of the vaccine and its administration by recognized providers. The coinsurance or co-payment applies after the yearly deductible has been met.

Other helpful information:

Despite Medicare coverage for influenza, pneumococcal, and hepatitis B vaccinations, the use of these benefits is not optimal. In 2002, almost 66% and 56% of people ages 65 and older reported receiving influenza and pneumococcal vaccinations, respectively.

CMS has a long history of working with the CDC and other outside organizations, including the National Coalition on Adult Immunization, to promote influenza and pneumococcal immunizations to Medicare beneficiaries. In addition to its national immunization campaign, CMS has implemented quality improvement efforts to improve rates in a variety of health care settings, including hospitals and nursing homes. CMS has also initiated changes in payment rates, billing processes, and the conditions of participation for nursing homes and home health agencies to facilitate the delivery of influenza and pneumococcal immunizations to Medicare beneficiaries.

The 2006-2007 Immunizers' Question & Answer Guide to Medicare Coverage of Influenza and Pneumococcal Vaccinations addresses immunizers' commonly asked questions about the administration of influenza and pneumococcal vaccines to Medicare patients.

Also...

http://www.cms.hhs.gov/AdultImmunizations/Downloads/fluguide0607rev.pdf

Also, you can bill for the administration of the Zostavax -- I write the Rx to have the patient pick up the zoster shot, then have them bring to the office and bill.

http://www.aafp.org/online/en/home/publications/news/news-now/practice-management/20070223vaccinecode.html

CMS has created a new "G" code -- G0377 -- specifically for the administration of Medicare Part D vaccines such as Zostavax. The code went into effect Jan. 1 and remains active for one year. It stipulates that payment for G0377 will be the same as for CPT code 90471, or $19.33 (national average).

Locke, MD

From: [mailto: ] On Behalf Of Kathy SaradarianSent: Saturday, December 08, 2007 4:32 PMTo: Subject: RE: medicare pricing on vaccines

,

I believe Medicare covers influenza, pneumococcal and hepatitis B only. They have their own CPT administration codes too (G codes)

Kathy Saradarian, MD

Branchville, NJ

www.qualityfamilypractice.com

Solo 4/03, Practicing since 9/90

Practice Partner 5/03

Low staffing

From: [mailto: ] On Behalf Of GuinnSent: Saturday, December 08, 2007 2:28 PMTo: Subject: medicare pricing on vaccines

I'm looking for a list of 2007 Medicare allowables for all the vaccines they cover.I've already got the Medicare fee schedule, I've found the HCPCS list, but those codes are not in there (90732, 90658, etc)Anyone know where they are?I'm in New Mexico, know eveything has a regional variation, but not certain that's the case with vaccines.Thanks,

[Guest guest]

BTW, I believe that Medicare won't cover "routine" boosters for Tetanus...only if indicated for booster -- ie step on nail.

But I could be wrong.

This article covers some info.

http://www.aetna.com/members/medicare/data/VaccineCoverageChart.pdf

http://www.umd.nycpic.com/faq0505.html#Q4

4. Should we bill Decavac under code J3490, as the other tetanus toxoids are billed, and would Depavac be a Medicare covered service? (Last Reviewed: March 30, 2006)Decavac is a preservative free tetanus and diphtheria toxoid. Medicare would only pay for tetanus toxoid when it is given proximate to an injury, where there was the potential danger of subsequent tetanus infection. Medicare would not cover routine adult immunization with this agent. If Decavac is used, this carrier will pay for tetanus toxoid 0.5 ml at $14.491 (PAR).

This is a nice article...

http://www.aafp.org/fpm/20070700/33bill.html

Part B or Part D?

Medicare covers three vaccines on a preventive basis under Part B: influenza, pneumococcal and hepatitis B (for those at high or intermediate risk). Medicare does cover other vaccines under Part B on a therapeutic basis (e.g., tetanus toxoid if a beneficiary steps on a rusty nail), but all other available vaccines not covered under Part B are covered under Part D.

Locke, MD

From: [mailto: ] On Behalf Of Kathy SaradarianSent: Saturday, December 08, 2007 4:32 PMTo: Subject: RE: medicare pricing on vaccines

,

I believe Medicare covers influenza, pneumococcal and hepatitis B only. They have their own CPT administration codes too (G codes)

Kathy Saradarian, MD

Branchville, NJ

www.qualityfamilypractice.com

Solo 4/03, Practicing since 9/90

Practice Partner 5/03

Low staffing

From: [mailto: ] On Behalf Of GuinnSent: Saturday, December 08, 2007 2:28 PMTo: Subject: medicare pricing on vaccines

I'm looking for a list of 2007 Medicare allowables for all the vaccines they cover.I've already got the Medicare fee schedule, I've found the HCPCS list, but those codes are not in there (90732, 90658, etc)Anyone know where they are?I'm in New Mexico, know eveything has a regional variation, but not certain that's the case with vaccines.Thanks,

[Guest guest]

Cheap place to get adult Td - Henry Schein, sometimes on sale for about $11/dose usually around $14. They get it from some lab in Massachusetts. Decavac is a lot more expensive but ?preservative free. Poison those patients with mercury!That is true about medicare and Td. You can always ask the patient to describe a small 'wound' somewhere, code the wound, give the tetanus. Such a game, this stuff drives me crazy. LynnTo: From: lockek@...Date: Sat, 8 Dec 2007 18:27:56 -0700Subject: RE: medicare pricing on vaccines

BTW, I believe that Medicare won't cover "routine" boosters for Tetanus...only if indicated for booster -- ie step on nail.

But I could be wrong.

This article covers some info.

http://www.aetna.com/members/medicare/data/VaccineCoverageChart.pdf

http://www.umd.nycpic.com/faq0505.html#Q4

4. Should we bill Decavac under code J3490, as the other tetanus toxoids are billed, and would Depavac be a Medicare covered service? (Last Reviewed: March 30, 2006)Decavac is a preservative free tetanus and diphtheria toxoid. Medicare would only pay for tetanus toxoid when it is given proximate to an injury, where there was the potential danger of subsequent tetanus infection. Medicare would not cover routine adult immunization with this agent. If Decavac is used, this carrier will pay for tetanus toxoid 0.5 ml at $14.491 (PAR).

This is a nice article...

http://www.aafp.org/fpm/20070700/33bill.html

Part B or Part D?

Medicare covers three vaccines on a preventive basis under Part B: influenza, pneumococcal and hepatitis B (for those at high or intermediate risk). Medicare does cover other vaccines under Part B on a therapeutic basis (e.g., tetanus toxoid if a beneficiary steps on a rusty nail), but all other available vaccines not covered under Part B are covered under Part D.

Locke, MD

From: [mailto: ] On Behalf Of Kathy SaradarianSent: Saturday, December 08, 2007 4:32 PMTo: Subject: RE: medicare pricing on vaccines

,

I believe Medicare covers influenza, pneumococcal and hepatitis B only. They have their own CPT administration codes too (G codes)

Kathy Saradarian, MD

Branchville, NJ

www.qualityfamilypractice.com

Solo 4/03, Practicing since 9/90

Practice Partner 5/03

Low staffing

From: [mailto: ] On Behalf Of GuinnSent: Saturday, December 08, 2007 2:28 PMTo: Subject: medicare pricing on vaccines

I'm looking for a list of 2007 Medicare allowables for all the vaccines they cover.I've already got the Medicare fee schedule, I've found the HCPCS list, but those codes are not in there (90732, 90658, etc)Anyone know where they are?I'm in New Mexico, know eveything has a regional variation, but not certain that's the case with vaccines.Thanks,

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[Guest guest]

LOL - , we could have discussed this in the office!I googled all the codes, didn't find this slide set. One what obscure fee schedule does Medicare offer this information - since it's not on the regular fee schedule, nor the HCPCs schedule. Flu and Pneumococcal90732 $27.03 G0009 V03.8290660 $21.18 G0008 V04.8190658 $12.62 G0008 V04.8190656 $16.57 G0008 V04.81Code Allowable Administration ICD-9-CMFlu and Pneumonia on the same dayV06.6 instead of V04.81 and V03.82http://www.mmgma.com/programs/ri_prez07/Medicare.pdfslide 11 Guinn wrote:>> I'm looking for a list of 2007 Medicare allowables for all the> vaccines they cover.> I've already got the Medicare fee schedule, I've found the HCPCS> list, but those codes are not in there (90732, 90658, etc)> Anyone know where they are?> I'm in New Mexico, know eveything has a regional variation, but not> certain that's the case with vaccines.> Thanks,> >> > ---------------------------------------------------------->> No virus found in this incoming message.> Checked by AVG Free Edition. > Version: 7.5.503 / Virus Database: 269.16.15/1174 - Release Date: 12/6/2007 10:11 AM> 

[Guest guest]

They don't cover routine Td's, you are right - only if it's associated with a wound. Can't remember who on this list serve first explained that. Sorry, I"d give you credit otherwise : )BTW, I believe that Medicare won't cover "routine" boosters for Tetanus...only if indicated for booster -- ie step on nail. But I could be wrong. This article covers some info. http://www.aetna.com/members/medicare/data/VaccineCoverageChart.pdf http://www.umd.nycpic.com/faq0505.html#Q4 4. Should we bill Decavac under code J3490, as the other tetanus toxoids are billed, and would Depavac be a Medicare covered service? (Last Reviewed: March 30, 2006)Decavac is a preservative free tetanus and diphtheria toxoid. Medicare would only pay for tetanus toxoid when it is given proximate to an injury, where there was the potential danger of subsequent tetanus infection. Medicare would not cover routine adult immunization with this agent. If Decavac is used, this carrier will pay for tetanus toxoid 0.5 ml at $14.491 (PAR). This is a nice article... http://www.aafp.org/fpm/20070700/33bill.htmlPart B or Part D?Medicare covers three vaccines on a preventive basis under Part B: influenza, pneumococcal and hepatitis B (for those at high or intermediate risk). Medicare does cover other vaccines under Part B on a therapeutic basis (e.g., tetanus toxoid if a beneficiary steps on a rusty nail), but all other available vaccines not covered under Part B are covered under Part D.  Locke, MDFrom:  [mailto: ] On Behalf Of Kathy SaradarianSent: Saturday, December 08, 2007 4:32 PMTo:  Subject: RE: medicare pricing on vaccines,I believe Medicare covers influenza, pneumococcal and hepatitis B only.  They have their own CPT administration codes too (G codes) Kathy Saradarian, MDBranchville, NJwww.qualityfamilypractice.comSolo 4/03, Practicing since 9/90Practice Partner 5/03Low staffing   From:  [mailto: ] On Behalf Of  GuinnSent: Saturday, December 08, 2007 2:28 PMTo:  Subject:  medicare pricing on vaccines I'm looking for a list of 2007 Medicare allowables for all the vaccines they cover.I've already got the Medicare fee schedule, I've found the HCPCS list, but those codes are not in there (90732, 90658, etc)Anyone know where they are?I'm in New Mexico, know eveything has a regional variation, but not certain that's the case with vaccines.Thanks,

[Guest guest]

Try this website .

http://www.oknmmedicare.com/provider/viewarticle.aspx?articleid=2349

Medicare reimburses vaccines at 95% of AWP. says that this is an

ethereal number, but you can look at the Redbook.

Try this website too.

http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5744.pdf

Guinn wrote:

>

> LOL - , we could have discussed this in the office!

>

> I googled all the codes, didn't find this slide set.

>

> One what obscure fee schedule does Medicare offer this information -

> since it's not on the regular fee schedule, nor the HCPCs schedule.

>

>

>

>

>

>

>> Flu and Pneumococcal

>> 90732 $27.03 G0009 V03.82

>> 90660 $21.18 G0008 V04.81

>> 90658 $12.62 G0008 V04.81

>> 90656 $16.57 G0008 V04.81

>> Code Allowable Administration ICD-9-CM

>> Flu and Pneumonia on the same day

>> V06.6 instead of V04.81 and V03.82

>>

>> http://www.mmgma.com/programs/ri_prez07/Medicare.pdf

>> <http://www.mmgma.com/programs/ri_prez07/Medicare.pdf>

>> slide 11

>>

>> Guinn wrote:

>> >

>> > I'm looking for a list of 2007 Medicare allowables for all the

>> > vaccines they cover.

>> > I've already got the Medicare fee schedule, I've found the HCPCS

>> > list, but those codes are not in there (90732, 90658, etc)

>> > Anyone know where they are?

>> > I'm in New Mexico, know eveything has a regional variation, but not

>> > certain that's the case with vaccines.

>> > Thanks,

>> >

>> >

>> >

>> > ----------------------------------------------------------

>> >

>> > No virus found in this incoming message.

>> > Checked by AVG Free Edition.

>> > Version: 7.5.503 / Virus Database: 269.16.15/1174 - Release Date:

>> 12/6/2007 10:11 AM

>> >

>>

>

>

> ------------------------------------------------------------------------

>

> No virus found in this incoming message.

> Checked by AVG Free Edition.

> Version: 7.5.503 / Virus Database: 269.16.17/1178 - Release Date: 12/8/2007

11:59 AM

>