- Outpatient Institutional Providers Reimbursed Under MPFS: When to Split Claims for Updated Rates
- Preventive Vaccines for FQHCs and RHCs Guidance
- Outpatient Services for Registered Inpatients
- Allergen Immunotherapy Preparation (95144-95165)
- Ambulatory Surgical Center Approved HCPCS Codes and Payment Rates
- Billing for FQHC MAO Plan Supplemental Payment (PPS Providers)
- Billing for Services Not Included in the FQHC Benefit
- Attention all OPPS Providers: Provider-Based Department Edits Being Implemented on/after 8/1/2023
- Billing for Drug Wastage: JW and JZ Modifier
- Billing Medicare for a Denial - Condition Code 21
- URGENT: Billing Reminders for OPPS Providers with Multiple Service Locations
- Incarcerated or Unlawfully present in the US claim rejections (U538H, U538Q)
- Billing Medicare Part A When Veteran’s Administration Eligible Medicare Beneficiaries Receive Services in Non-VA Facilities
- Condition Code G0 Reminder
- CPT Code 15830: Excision, Excess Skin and Subcutaneous Tissue; Abdomen, Infraumbilical Panniculectomy
- Medicare Part B Electronic Claims that Exceed the Threshold for Charges and Units of Service
- ESRD Facilities: Clarification for Providing Dialysis Services to Patients Acute Kidney Injury
- Federally Qualified Health Centers Behavioral Health Claims Job Aid
- Federally Qualified Health Centers Contracting with Medicare Advantage Plans
- Fee-For-Time Compensation Arrangement and Reciprocal Billing Job Aid
- Answers to Common Fee-for-Time Compensation Arrangements Questions
- FQHC and Group Therapy Services Job Aid
- Inhalation Treatment CPT 94640 – Billing Errors
- Immunization Roster Billing
- Nonphysician Practitioners Billing for Surgical Procedures
- Professional Services During a Patient Hospice Election
- Professional Services During a Patient Hospice Election
- Proper Billing for Finger and Toe Procedures
- Proper Submission of Fee-For-Time Compensation Arrangements and Reciprocal Billing Arrangements
- Proper Use of Taxonomy Codes
- A/B Rebilling Facts
- Common Reciprocal Billing Questions and Answers
- Reminder for Avoiding Claim Denials for Positron Emission Tomography Scans
- Reminder on Deleting Revenue Code Line(s) in the Fiscal Intermediary Standard System Direct Data Entry System
- Repetitive Outpatient Services for Providers Submitting Institutional Outpatient Claims
- Reporting Multiple Qualifying Visits on the Same Date of Service for FQHC Reimbursement
- Unlisted and Not Otherwise Classified Procedure Codes
- What All Facilities Need to Know About the Long-Term Care Hospital Three-Day or Less Interrupted Stay Policy
- Fiscal Year/Calendar Year Claim Split
Preventive Vaccines for FQHCs and RHCs Guidance
Effective 7/1/2025, FQHCs and RHCs will bill and receive payment for all four types of Part B preventive vaccines (pneumococcal, influenza, COVID-19 and hepatitis B) and their administration at the time of service.
Summary of Changes
- Part B preventive vaccines and their administration will be billed on the UB-04 claim form (TOB 77X or 71X).
- A visit/encounter or qualifying visit code is NOT required to be reported on the same claim as these Part B preventive vaccines to receive separate reimbursement.
- Use HCPCS Level II code M0201 to bill for the additional payment for administering the vaccine to Medicare patients in their homes under certain circumstances.
- The roster billing process will be updated to allow entry for TOB 77X and 71X
- Separate payment will be made at the lesser of 95% of the AWP or the submitted charges for service lines reporting Part B preventive vaccine products when reported on TOB 77X or 71X.
- A separate payment at the lesser of the MPFS rates or the submitted charges for service lines reporting Part B preventive vaccine administration codes will also be made.
- Beneficiary coinsurance and deductible will be waived for Part B preventive vaccine products and administration.
Billing Instructions
Bill on FQHC TOB (77X) or RHC (71X) claim
- Report condition code A6
- Report appropriate administration code with revenue code 0771
- G0008 – influenza
- G0009 – pneumococcal
- G0010 – hepatitis B
- 90480 – COVID-19
- M0201 – in-home vaccine administration (reported in addition to administration code)
- Report the appropriate Part B vaccine code with revenue code 0636
- Report ICD-10-CM code: Z23
Special Instructions for FQHCs
- May be billed alone or with FQHC qualifying visit
- If qualifying visit occurs on the same day as a preventive vaccine, report the vaccine on the claim in addition to the FQHC payment code (G-code) and qualifying visit
- Report condition code A6 so that coinsurance is not applied to the preventive vaccine
- If no qualifying visit occurs, submit the preventive vaccine claim (77X TOB) with the appropriate revenue codes and CPT/HCPCS codes for the administration and vaccine for payment to be made
- If qualifying visit occurs on the same day as a preventive vaccine, report the vaccine on the claim in addition to the FQHC payment code (G-code) and qualifying visit
Special instructions for RHCs
- Qualifying visit not required to be billed on vaccine claims
- RHC claims are not required to report the CG modifier on the vaccine or administration line
Cost Report
Although paid on the claim, RHCs and FQHCs must reconcile the claim payments with actual vaccine costs, and these services are ultimately reimbursed at 100% of reasonable costs through the cost report.
Related Content
- MLN Matters® MM13923: Payment for Medicare Part B Preventive Vaccines & Their Administration for Rural Health Clinics & Federally Qualified Health Centers
- Centers for Medicare & Medicaid Services Internet-Only Manual Publication 100-04, Medicare Claims Processing Manual, Chapter 18, Section 10.2.2.2
- CMS Vaccine Pricing
- Preventive Services
- In-Home Vaccine Administration: Additional Payment
Posted 7/1/2025