What was the rationale for establishing a tiering date for the 2005-06 influenza vaccination season?
The Centers for Disease Control (CDC) has developed a timeframe that (1) recognizes the need to make the
first doses of vaccine available to people at the highest risk of complications as well as health care
workers and those in close contact with children less than 6 months of age, and (2) ensures that providers can
effectively plan and deliver vaccine to others in a timely manner.
If a beneficiary receives a flu vaccination more than once in a 12-month period,
will Medicare still pay for it?
Yes. Medicare pays for one flu vaccination per flu season however, a beneficiary could
receive the flu vaccine twice in a calendar year for two different flu seasons and the
provider would be reimbursed for each. For example, a beneficiary could receive a flu
vaccination in January 2006 for the 2005-06 flu season and another flu vaccination in
November 2006 for the 2006-07 flu season and Medicare would pay for both vaccinations.
Will Medicare pay for the PPV vaccination if a beneficiary is uncertain of his or her vaccination history?
Yes. If a beneficiary is uncertain about his or her vaccination history in the past five years,
the vaccine should be given and Medicare will cover the revaccination. If a beneficiary is
certain that more than five years have passed, revaccination is not appropriate unless the
beneficiary is at highest risk.
When a beneficiary receives both the influenza and PPV vaccines on the same visit,
would a provider continue to report separate administration codes for each type of vaccine?
Yes. Although the provider would use diagnosis code V06.6 when an individual receives both
vaccines, separate administration codes for influenza (G0008) and PPV (G0009) should be reported.
What is a mass immunizer?
A mass immunizer offers flu and/or PPV vaccinations to a large number of individuals and may be a traditional
Medicare provider or supplier or a nontraditional provider or supplier (such as a senior citizen&rsquot;s center, a
public health clinic, or community pharmacy). Mass immunizers must submit claims for immunizations on roster
bills and must accept assignment on both the vaccine and its administration. A mass immunizer should enroll
with the Carrier by the June prior to flu season.
Does a deductible or coinsurance apply for adult immunizations covered by Medicare?
Neither a deductible nor coinsurance applies to the influenza virus vaccine or Pneumococcal Polysaccharide Vaccine (PPV).
Why was October 24 chosen as a tiering date?
Demand for influenza vaccine falls off quickly after November, even when there is a shortage. The planning
team has tried to balance two competing priorities: (1) ensuring an ample opportunity to vaccinate persons
at highest risk of complications from influenza, providers who care for them, and close contacts of
children less than 6 months of age, and (2) allowing ample time to vaccinate other priority groups and those
desiring vaccination before demand declines. Community vaccinators and health officials generally
need at least 4 - 5 weeks for optimal planning efforts. The 2005-06 influenza season planning team
concluded that October 24, 2005 was the best date to achieve a balance between these priorities.
Why have there been shortages or delays in the influenza vaccine
supply during three of the last five influenza seasons?
Influenza viruses change from year to year, so influenza vaccines must be
updated annually to include the viruses that will most likely circulate in the upcoming season.
There is a very tight timeline for selecting the influenza vaccine virus strains, preparing the
vaccine (which is a very complex process), manufacturing, and distributing the vaccine. Due to the
time constraints, any problems encountered during the process may cause shortages or delays.
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