Preventive Services

No, providers may not bill Medicare Part B for administering Part D vaccines.

Resource: CMS MLN Medicare Part D Vaccines Fact Sheet.

Last Reviewed: 12/14/2024

No, shingles vaccines are not covered under Part B Medicare. The shingles (herpes zoster) vaccine is a preventive vaccine that can be covered by Part D Medicare. Contact the patient’s Medicare Part D plan to verify their coverage of the shingles vaccine.

Last Reviewed: 12/14/2024

Yes. Railroad Medicare covers CPT® code 90714 and CPT® code 90715 for tetanus antitoxin or booster vaccines when the vaccine is directly related to the treatment of an injury or direct exposure to a disease or condition. Medicare does not cover routine tetanus booster shots in the absence of injury or direct exposure.

Last Reviewed: 12/14/2024

Table 1. Preventive Immunization.

Preventive Immunization	HCPCS Code
Influenza Virus Vaccine	G0008
Pneumococcal Vaccine	G0009
Hepatitis B Vaccine	G0010

CPT® codes 90471 and 90472 will be denied when billed as the administration code for a preventive immunization that has been assigned a specific administration code.

For more information on billing preventive immunizations, see the CMS Medicare Preventive Services Tool.

Last Reviewed: 12/14/2024

Medicare Part B covers the following immunizations:

• Hepatitis B vaccine (for patients at high or intermediate risk)
• Influenza virus vaccine
• Pneumococcal pneumonia vaccine
• COVID-19 vaccine
• Vaccines directly related to the treatment of an injury or direct exposure to a disease or condition

Resources

• CMS IOM Pub.100-02, Medicare Benefit Manual, Chapter 15, Section 50.4.4.2, Immunizations (PDF)
• Medicare Preventive Services Tool

Last Reviewed: 12/14/2024

Except for vaccines covered under Medicare Part B, Medicare Part D plans generally cover all commercially available vaccines as long as the vaccine is reasonable and necessary to prevent illness. This includes preventive shingles (herpes zoster) vaccines and TDAP vaccines.

Part D plans may have special rules, such as prior authorization, step therapy and quantity limits. Contact your patient’s plan to find out about coverage.

Resource: CMS MLN Medicare Part D Vaccines Fact Sheet.

Last Reviewed: 12/14/2024

The CMS MLN Medicare Preventive Services Educational Tool includes coding, coverage, frequency, and what the beneficiary pays for Medicare covered preventive services.

Last Reviewed: 12/14/2024