National Government Services, Inc. Medicare Monthly Review Part A and B
A Combined Part A and Part B Newsletter

Important Notice Regarding Vaccine Administrations in 2008

Note: This article was revised on August 3, 2007, to correct the G code for the administration of vaccinations for Part D. The G code referenced was G3077 and it should have been G0377. Also, a reference to a related article (SE0727) was added in the Additional Information section. All other information is unchanged.

Provider Types Affected
Physicians and other providers who bill Medicare carriers or Medicare Administrative Contractors (A/B MAC) for the administration of Part D-covered vaccines to Medicare beneficiaries

What Providers Need to Know
This article (Special Edition (SE) 0723) provides 2008 payment guidance for the administration of Part D-covered vaccines. This is not new policy guidance, just a reminder of the policy for 2008. Remember that, effective January 1, 2008, physicians can no longer bill Medicare Part B for the administration of Medicare Part D-covered vaccines, using the special G code (G0377). Instead, you will need to bill the patient for the vaccine and its administration, and the patient will need to submit the claim to their Part D plan for reimbursement.

You should make sure that your billing staffs are aware of this Part D-covered vaccine administration guidance for 2008.

Background
Section 202(b) of the Tax Relief and Health Care Act of 2006 (TRHCA) established a permanent policy for payment by Medicare for administration of Part D-covered vaccines, beginning in 2008. Specifically, the policy states that, effective January 1, 2008, the administration of a Part D-covered vaccine is included in the definition of “covered Part D drug” under the Part D statute.

During 2007, in transition to this new policy, providers were permitted to bill Part B for the administration of a Part D vaccine using a special G code (G0377). SE0723 now reminds providers of the requirement that payment for the administration of Part D covered vaccines only during 2007.

Therefore, effective January 1, 2008, you can no longer bill the G code to Part B; rather you will need to bill the patient for the vaccine and its administration, and the patient will need to submit the claim to the Part D plan for reimbursement.

Important Note: This guidance does not affect Part B covered vaccines. 

Additional Information
You might want to look at MLN Matters articles MM5486 (Payment by DME MACs and DMERCs for the Administration of Part D Vaccines), released December 29, 2006; and MM5459 (Emergency Update to the 2007 Medicare Physician Fee Schedule Database (MPFSDB)) released January 11, 2007. You can find these articles at http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5486.pdf and http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5459.pdf , respectively.

You may also want to review SE0727 (Reimbursement for Vaccines and Vaccine Administration Under Medicare Part D), which may be found at http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0727.pdf on the CMS Web site.

If you have any questions, please contact your carrier or A/B MAC at their toll-free number, which may be found at http://www.cms.hhs.gov/MLNProducts/downloads/CallCenterTollNumDirectory.zip .

Disclaimer
This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.

MLN Matters Number: SE0723 Revised
Related Change Request (CR) #: N/A
Related CR Release Date: N/A
Effective Date: N/A
Related CR Transmittal #: N/A
Implementation Date: N/A

Medicare Advantage Enrolled Beneficiaries
If you treat a Medicare Advantage enrolled beneficiary and you have questions about their Medicare Advantage Plan, you may wish to contact that plan. A plan directory and MA claims processing contact directory are available at http://www.cms.hhs.gov/MCRAdvPartDEnrolData/ on the CMS Web site. CMS updates this site on a monthly basis.