Content Section
Note: Should you have landed here as a result of a search engine (or other) link, be advised that these files contain material which is copyrighted by the American Medical Association (AMA). You are forbidden to download the files unless you read, agree to and abide by the provisions of the copyright statement. Read the copyright statement now (you will be linked back to here).
|
The Zostavax ® vaccine for prevention of shingles (herpes zoster) is excluded from Medicare coverage. Medicare manual instructions [ Medicare Benefits Manual (Pub. 100-02), Chapter 15, Section 50.4.4.2 – Immunizations ] (see below) prohibit coverage unless the beneficiary is at risk directly related to exposure to a pathogen. In the absence of an immunocompromised state, beneficiaries are not at direct risk for developing herpes zoster. In an immunocompromised state, the vaccine is contraindicated and should not be administered. Therefore, neither the vaccine nor its administration can be covered by Medicare.
Medicare Benefits Manual (Pub. 100-02), Chapter 15 50.4.4.2 – Immunizations
(Rev. 1, 10-01-03) A3-3157.A, B3-2049.4, HO-230.4.C
Vaccinations or inoculations are excluded as immunizations unless they are directly related to the treatment of an injury or direct exposure to a disease or condition, such as anti-rabies treatment, tetanus antitoxin or booster vaccine, botulin antitoxin, antivenin sera, or immune globulin. In the absence of injury or direct exposure, preventive immunization (vaccination or inoculation) against such diseases as smallpox, polio, diphtheria, etc., is not covered. However, pneumococcal, hepatitis B, and influenza virus vaccines are exceptions to this rule….In cases where a vaccination or inoculation is excluded from coverage, related charges are also not covered.
Posted: 11/20/2006
CPT codes, descriptions, and
other data only are copyright 2006 American Medical Association
(or such other date of publication of CPT). All Rights Reserved.
Applicable FARS/DFARS Apply.
|
