Corporate

November 6, 2018

Coverage of Vaccines: Part B vs. Part D

As your Part B Medicare Administrative Contractor (MAC), CGS processes claims for vaccines covered under the Part B benefit. The Part B program covers most of the vaccines directed for the Medicare population, with the prescriber administering the vaccine and billing the Part B contractor for both the vaccine and its associated administration.

  Covered Under Part B? Is the Administration Covered?
Influenza Virus Vaccine YES YES
Pneumococcal Pneumonia Vaccine YES YES
Hepatitis B Vaccine YES – For intermediate and high risk patients YES
NO – For no/low-risk patients (refer to patient's Medicare Part D plan) NO – Check with patient's Medicare Part D plan
Tetanus Toxoid YES – To treat an injury or illness YES
NO – Absence of injury or illness (refer to patient's Medicare Part D plan) NO – Check with patient's Medicare Part D

Please keep in mind, in all situations; Medicare Part B does not cover the administration of vaccines not covered under the Part B Benefit. Please contact the patient's Part D plan regarding coverage of additional drugs and administration.

For additional information on Part B and Part D vaccines and its administration, please reference the following:

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