Administration Rates and Coverage
This page provides general facts about adult immunization and links to other resources. For updated administration rates and resources, visit the CMS website. Scroll down to the ‘Downloads’ section for current reimbursement rates, an immunizer’s guide, a flu poster and more.
Blue Cross Blue Shield of Michigan’s Commercial Prescription Drug Plan Vaccine Program
As of October 1, 2016, BCBS of Michigan expanded access to immunizations to many patients through their commercial plans under prescription drug benefits. BCBS created this FAQ document to assist pharmacies with proper utilization and billing procedures.
Mass Immunizers and Roster Billing Fact Sheet
If you decide to become a mass immunizer, you may take advantage of roster billing, which is a streamlined process for submitting health care claims for a large group of beneficiaries for seasonal influenza and/or pneumococcal vaccinations. Visit the CMS website to access a fact sheet on this type of immunization billing.
Medicare Mass Immunization Enrollment Form
Visit the CMS website to access the Medicare Mass Immunization Enrollment form.
Medicare Part B Drug Average Sales Price (ASP)
For updated fees and codes, visit the CMS website. Find the link on the left for the current year of ASP drug pricing files, then scroll down to the ‘Downloads’ section.
Physician Fee Schedule Search
This Web site is designed to provide information on services covered by the Medicare Physician Fee Schedule. It provides more than 10,000 physician services, the associated relative value units, a fee schedule status indicator and various payment policy indicators needed for payment adjustment (i.e., payment of assistant at surgery, team surgery, bilateral surgery, etc.). Visit the CMS website for additional information.
Question and Answer Guide to Medicare Part B, Medicaid and CHIP Coverage of Seasonal Influenza and Pneumococcal Vaccinations
This document addresses immunizers’ commonly asked questions about the administration of influenza and pneumococcal vaccines to Medicare, Medicaid and CHIP patients. It also includes questions and answers that are particularly relevant to the influenza immunization season. Visit the CMS website to access the guide.
Quick Reference Information: Medicare Immunization Billing
For quick reference information on Medicare preventative services, including Medicare Part B Immunization Billing (Influenza, Pneumococcal and Hepatitis B), visit the CMS website.
Seasonal Influenza Vaccines Pricing
Payment allowances listed on the CMS website reflect the annually updated payment allowance for the listed CPT codes and Q-codes when the seasonal flu vaccines are furnished outside the hospital outpatient department.