AHCA Provides Medicare Billing Guidance for Respiratory Vaccines

AHCA reports that long-term care facilities can bill Medicare for four common respiratory vaccines: RSV, Influenza, Pneumococcal and COVID. Additional details include the following:

• All Part B vaccines (e.g., Influenza, Pneumococcal and COVID) are subject to consolidated billing and must be submitted by a Skilled Nursing Facility on either a separate inpatient or outpatient Part B claim. It is paid separately from any Part A bundled rate when it is for preventative and not therapeutic purposes.
• Part D vaccines (which include RSV) are covered only under Part D and are not covered by Part A or B. The RSV vaccine is not subject to consolidated billing. It can be billed by any outside pharmacy or other entity regardless of SNF Part A (if preventative) or long-stay status. Therapeutic use of a Part D vaccine (e.g., tetanus for a person exposed) during a Part A stay would be bundled into the Part A per-diem rate (Part A is primary payer) and could not be billed separately to Part D.
• For the RSV vaccine that is not covered by Part B benefits but is covered by Part D: If administered for preventive purposes, a Part D plan would pay any approved entity that administers the vaccine regardless of Part A status (not subject to SNF consolidated billing).
• Additional information is available.