Forum - Questions & Answers

Jun 5th, 2012 - kingwoodfp

Medicare Immunizations

What immunizations does Medicare cover/pay for? Our Dr is arguing that they should pay for a TDap immunization and our office manager says they will not...who's right?

Jun 5th, 2012 -

re: Medicare Immunizations

Of course the doctor is wrong. The doctor is referring to the recent FDA approval of administering Adacel/Boostrix to persons age 65 and over. Previously it was approved only for persons under the age of 65.

But of course FDA approval does not equal Medicare or private insurance coverage. And as with the regular tetanus shot, Medicare part B does not cover Adacel/Boostrix.

But...if they have a Medicare part D plan, it may cover it, just as it covers Zostavax. If you are signed up to bill Part D for Zostavax, you can search for coverage for this too. If not, you can sign up your practice here https://enroll.mytransactrx.com/ws_enroll/login.jsp?profile=TRANSACTRX

or refer the patient to the local pharmacy that offers vaccinations.

Jun 5th, 2012 - Codapedia Editor 1,399 

re: Medicare Immunizations

Saying that Medicare SHOULD cover is ... well, we can all agree they should.

Download this nice summary from CMS of what they do cover.

Zoster vaccine, btw, is covered by Part D, so they have to go to the pharmacy, as signature doc says.

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/qr_immun_bill.pdf

Jun 5th, 2012 -

re: Medicare Immunizations

thank you this helps



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