Effective January 1, 2025, Medicare will begin reimbursing hepatitis B vaccines in the same manner as other Part B preventive vaccines.
Effective July 1, 2025, Medicare will implement claim-based payments for Part B preventive vaccines and their administration in Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs). This change applies to pneumococcal, influenza, hepatitis B, and COVID-19 vaccines.
Key Changes:
- RHCs (bill type 71X) and FQHCs (bill type 77X) can now bill at the time of service for these vaccines and their administration.
- In-home vaccine administration (HCPCS code M0201) will also be reimbursed if specific regulatory requirements are met.
- Vaccines will be paid at 95% of their Average Wholesale Price (AWP); administration fees will follow the Medicare Physician Fee Schedule (MPFS).
- No visit/encounter code is required for reimbursement.
- Coinsurance and deductibles do not apply to these services.
These changes aim to streamline billing and ensure full reimbursement for vaccine-related services in RHCs and FQHCs under Medicare Part B.
The CMS MLN Matters release can be reviewed here.
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