Vaccine Reimbursement Support Center
This service is intended to provide physicians with possible solutions to the following types of inquiries:
- What is the appropriate CPT code to use when I submit claims for reimbursement?
- What should I do if a health plan denies or underpays my reimbursement claim?
- I’m not sure if my patient’s health plan will reimburse for a vaccine. How can I find out?
- My patient’s health plan requires a prior authorization to administer a vaccine. What is the process for submitting it?
- How does Medicare Part D apply to adult vaccines?
- Are adult vaccines reimbursed under Medicare Part D? How are claims submitted for vaccines reimbursed by Medicare Part D?
- How can I find out if an insurance company is reimbursing for a vaccine?
Here is how the Center may be able to help you
- Reimbursement issue
- Support service
- General coding or reimbursement questions
- The Center can provide general information about coding and billing processes for private sector health plans and Medicare.
- Denied or underpaid claim
- Complete a Request for Benefit Information form, located in the Letters and Forms section of this website. Return the form with the patient’s Explanation of Benefits (EOB). A specialist will research the denied/underpaid claim for you or provide you with suggestions for resubmitting.
- Unsure if your patient’s plan will reimburse for a vaccine
- Complete a Request for Benefit Information form, located in the Letters and Forms section of this website. A specialist will attempt to contact the payer to determine if the patient’s insurance will cover the vaccine.
- Prior authorization is required
- Complete a Request for Benefit Information form, located in the Letters and Forms section of this website. A specialist will work with your office and the payer throughout the process of obtaining an authorization.
- Unsure of how the Medicare Part D vaccine claim submittal process works, or which adult vaccines may be reimbursed under Part D
- See the Medicare Part D section of this website.
- Unsure if a payer has implemented reimbursement for a vaccine
- The Center may have general coverage information on file that can be provided to you.
Coding and coverage reference
- CPT Codes
Vaccine and administration codes listed twice on this site — sorted by vaccine category and sorted by code number.
Effective as of January 2005
- ICD-9-CM Codes
Vaccination V-codes payers may require to describe the disease for which the prophylactic vaccination is being administered.
Current as of November 2006
- Payer Coverage
Coverage material organised by state group and payer type, covering commercial, Medicaid fee-for-service and Medicaid managed care plans.
Last updated 01-Jan-08
Medicare update
MEDICARE UPDATE: New information regarding payment of administration fees for vaccines covered by Medicare Part D.
The Tax Relief and Health Care Act (TRHCA) of 2006, enacted by the federal government on 12/20/06, requires that Medicare providers be reimbursed for the administration of vaccines covered by Part D beginning 1/1/07. Per TRHCA, Part B will cover the administration fees in 2007 only, while Part D will cover for 2008 and thereafter.
Contact
The Center was reachable by phone, fax and e-mail. Voicemail was available to record requests received outside of normal business hours. All requests, regardless of how they were communicated (phone, fax, e-mail) were acknowledged within one business day of receipt.
Monday – Friday, 9:00 AM – 8:00 PM (EST)