Influenza and Pneumonia Vaccinations in the Home Health and/or Hospice Setting

During the current public health emergency for COVID-19, it is especially important to ensure that all patients are up-to-date with their influenza and pneumonia vaccinations.

Home health agencies are able to capture this information within the OASIS; M1041, M1046, M1051 and M1056. HHA bills under bill type 034x and reports revenue code 0636 along with the appropriate HCPCS code for the vaccine and revenue code 0771 along with the appropriate HCPCS code for the administration.

Hospice agencies can provide the influenza virus and pneumococcal vaccinations to beneficiaries who request them, including those who have elected the hospice benefit. These services may be covered when furnished by the hospice agency. Vaccinations provided by a hospice agency may be billed on an institutional claim to the Medicare contractor. Since these services are not part of the Medicare hospice benefit, they must be billed on a separate claim that includes only the vaccines and their administration.

For further information regarding the influenza and pneumonia vaccinations, please review the following materials from CMS:

• Flu Shot Payment Rates for 2020 - 2021
• Seasonal Influenza Vaccines Pricing
• CMS IOM Publication 100-02, Medicare Benefit Policy Manual, Chapter 15, Section 50.4.4.2, Immunizations
• CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 18, Section 10.2.3
• MLN Influenza Vaccine Payment Allowances – Annual Update for 2020 2021 Season
• Outcome and Assessment Information Set (OASIS) Guidance Manual