Medicare Part B and Part D vaccine coverage
Medicare vaccine coverage is complicated. Here's what you need to know to bill and code correctly.
Overview: Medicare vaccine coverage
Medicare covers four vaccines on a preventive basis under Part B: COVID, hepatitis B (for those at high or intermediate risk), influenza and pneumococcal.
Coverage of other vaccines provided as a preventive service, including respiratory syncytial virus vaccine, may be covered under a patient's Part D coverage.
Medicare also covers other vaccines under Part B on a therapeutic basis. For example, Part B would cover a tetanus toxoid shot if a beneficiary stepped on a rusty nail, or a rabies shot if a beneficiary was bitten by an animal.
All other available vaccines not covered under Part B are covered under Part D.
Preventive vaccines covered under Medicare Part B
| COVID | Hepatitis B | Influenza | Pneumococcal | |
| Diagnosis code | Z23 Encounter for immunization | |||
| Admin codes | 90480 | G0010 | G0008 | G0009 |
| Vaccine codes |
|
for persons at intermediate to high risk |
once per flu season |
once per lifetime with high-risk booster after five years |
Chart detailing preventive vaccine coverage and codes for Medicare Part B
Billing considerations for Part B vaccines
Deductibles and co-insurance: As of January 1, 2025, hepatitis B vaccines are paid like other Part B preventive vaccines, meaning the four vaccines noted in the chart above, and the administration of those vaccines, are not subject to the Medicare Part B deductible or co-insurance. Medicare pays at 100% of the allowable amounts.
Physician order requirements for hepatitis B: Claims for the hepatitis B vaccine must include the name and National Provider Identifier of the ordering physician, as Medicare requires that the hepatitis B vaccine be administered under a physician’s order with supervision. This is not necessary for the influenza and pneumococcal vaccines for which Medicare does not require a physician's order or supervision. Note that state law may require an order and/or supervision.
Assignment rules for participating vs. nonparticipating providers: Whether participating or nonparticipating in Medicare, physicians must accept assignment of the Medicare vaccine payment rate and may not collect payment from the beneficiary for the vaccine. Nonparticipating physicians may choose not to accept assignment on the administration fee. When a nonparticipating physician or supplier provides the services, the beneficiary is responsible for paying the difference between what the physician or supplier charges and the amount Medicare allows for the administration fee. The limiting charge provision does not apply to the influenza benefit.
Same-day administration of multiple vaccines: Medicare will pay two administration fees if a beneficiary receives both the influenza virus and the pneumococcal vaccine on the same day.
Medicare Part D: Vaccine coverage
Payment for Part D-covered vaccines and their administration are made solely by the participating prescription drug plan. This includes all preventive vaccines not covered under Medicare Part B.
When providing a Part D covered vaccine to a Medicare patient, the physician should charge the patient for the vaccine and its administration. To facilitate the patient's reimbursement by his or her Part D plan, the physician's office should complete a CMS-1500 claim form for the vaccine and administration service and give it to the patient to file as an unassigned, out-of-network claim.
Some patients may also request a prescription for preventive vaccines and their administration to meet their Part D plan requirements to have this prescription filled by contracted providers (pharmacy and injection clinic).
