- Preventive Services Guide
- Medicare Preventive Services Resource Guide
- Alcohol Misuse and Counseling
- Annual Wellness Visit Screening
- Bone Mass Measurements
- Cardiovascular Disease Screening Tests
- Colorectal Cancer Screening
- Counseling to Prevent Tobacco Use
- Depression Screening
- Diabetes Screening
- Diabetes Self-Management Training
- Glaucoma Screening
- Hepatitis B Virus Screening
- Hepatitis B Virus Vaccine and Administration
- Hepatitis C Virus Screening
- Human Immunodeficiency Virus Screening
- Influenza Virus Vaccine and Administration
- Initial Preventive Physical Examination
- Intensive Behavioral Therapy for Cardiovascular Disease
- Intensive Behavioral Therapy for Obesity
- Lung Cancer Screening Counseling and Annual Screening for Lung Cancer with Low-Dose Computed Tomography
- Medical Nutrition Therapy
- Pneumococcal Vaccine and Administration
- Prolonged Preventive Services
- Prostate Cancer Screening
- Screening for Cervical Cancer with Human Papillomavirus Tests
- Screening for Sexually Transmitted Infections and HIBC to Prevent STIs
- Screening Mammography
- Screening Pap Tests
- Screening Pelvic Examinations
- Ultrasound Screening for Abdominal Aortic Aneurysm
- Vaccinations
- Related Articles
- Medicare Preventive Services Resource Guide
- The Annual Wellness Visit
- Medicare’s Annual Wellness Visit in Illinois: Understanding the Benefit and Preventing Denials
- Medicare’s Annual Wellness Visit in Minnesota: Understanding the Benefit and Preventing Denials
- Medicare’s Annual Wellness Visit in Wisconsin: Understanding the Benefit and Preventing Denials
Vaccinations
Part B Medicare provides coverage for specific vaccination types:
Seasonal Influenza Virus
Annual Influenza Vaccine season starts August 1 and ends July 31 of the following year.
Payment Allowances and Effective Dates for the 2023-2024 Flu Season
| Code | Labeler Name | Drug Name | Payment Allowance | Effective Dates |
|---|---|---|---|---|
| 90662 | Sanofi Pasteur | Fluzone High-Dose Quadrivalent (2023/2024) | $73.403 | 8/1/2023‒7/31/2024 |
| 90672 | MedImmune | FluMist Quadrivalent (2023/2024) | $27.788 | 8/1/2023‒7/31/2024 |
| 90674 | Seqirus | Flucelvax Quadrivalent (2023/2024) (Preservative Free) | $34.172 | 8/1/2023‒7/31/2024 |
| 90682 | Sanofi Pasteur | Flublok Quadrivalent (2023/2024) (Preservative Free) | $73.403 | 8/1/2023‒7/31/2024 |
| 90686 | GlaxoSmithKline Sanofi Pasteur Seqirus |
Fluarix Quadrivalent (2023/2024) (Preservative free) Flulaval Quadrivalent (2023/2024) (Preservative Free) Fluzone Quadrivalent (2023/2024) (Preservative Free) Afluria Quadrivalent (2023/2024) (Preservative Free) |
$22.350 | 8/1/2023‒7/31/2024 |
| 90687 | Sanofi Pasteur Seqirus |
Fluzone Quadrivalent 0.25ml (2023/2024) Afluria Quadrivalent 0.25ml (2023/2024) |
$10.439 | 8/1/2023‒7/31/2024 |
| 90688 | Sanofi Pasteur Seqirus |
Fluzone Quadrivalent (2023/2024) Afluria Quadrivalent (2023/2024) |
$20.878 | 8/1/2023‒7/31/2024 |
| 90694 | Seqirus | Fluad Quadrivalent (2023/2024) (Preservative Free) | $77.359 | 8/1/2023‒7/31/2024 |
| 90756 | Seqirus | Flucelvax Quadrivalent (2023/2024) | $32.374 | 8/1/2023‒7/31/2024 |
For the most up to date list of billing codes, payment allowances and effective dates for the 2023-2024 flu season, please see Seasonal Influenza Vaccines Pricing.
For influenza virus vaccination, the following ICD-10 diagnosis codes apply:
- Z23
Additional ICD-10 codes may apply. See CMS ICD-10 webpage for individual CRs and the specific ICD-10-CM codes Medicare covers for this service.
Influenza Vaccination: Who is Covered/Frequency
- All Medicare beneficiaries
- Once per influenza season (Medicare covers additional flu shots in medically necessary)
Influenza Vaccination: Other Notes
- Copayment, coinsurance, deductible waived
- As a reminder, please review and use the appropriate flu vaccine code to avoid processing delays and claim denials on the CMS Seasonal Influenza Vaccines Pricing web page.
- Pricing information for the G0008 administration code is located on the Vaccines and Administration Pricing section on the Fee Schedule Lookup web page.
- Starting 1/1/2024 Medicare pays an additional payment for in-home flu shot administration under certain circumstances.
Pneumococcal
For pneumococcal vaccination, the following procedure codes apply:
| Procedure/ HCPCS Code |
Code Description |
|---|---|
| 90670 | Pneumococcal conjugate vaccine, 13-valent (PCV13), for intramuscular use |
| 90671 | Pneumococcal conjugate vaccine, 15- valent (PCV15), for intramuscular use |
| 90677 | Pneumococcal conjugate vaccine, 20-valent (PCV20), for intramuscular use |
| 90732 | Pneumococcal polysaccharide vaccine, 23-valent (PPSV23), adult or immunosuppressed patient dosage, when administered to individuals 2 years or older, for subcutaneous or intramuscular use |
| G0009 | Administration of pneumococcal vaccine |
For pneumococcal vaccination, the following ICD-10 diagnosis codes apply:
- Z23
- Additional ICD-10 codes may apply. See CMS ICD-10 webpage for individual CRs and the specific ICD-10-CM codes Medicare covers for this service.
Pneumococcal Vaccination: Who is Covered/Frequency
- All Medicare beneficiaries
- An initial pneumococcal vaccine to Medicare beneficiaries who never received the vaccine under Medicare Part B
- A different, second pneumococcal vaccine one year after the first vaccine was administered
- Visit CDC’s Pneumococcal Vaccine Timing for Adults
Pneumococcal Vaccination: Other Notes
- Copayment, coinsurance, deductible waived
- Additional information on specific shots and administration timing to align with the Advisory Committee on Immunization Practices recommendations: MLN Matters® MM12723 Revised: Revisions to Medicare Part B Coverage of Pneumococcal Vaccinations for the Medicare Benefit Policy Manual Chapter 15, Section 50.4.4.2
- Starting 1/1/2024 Medicare pays an additional payment for in-home PPV shot administration under certain circumstances.
Hepatitis B
For HBV vaccinations, the following procedure codes apply:
| Procedure/ HCPCS Code |
Code Description |
|---|---|
| 90739 | Hepatitis B vaccine (HepB), adult dosage, 2 dose schedule, for intramuscular use |
| 90740 | Hepatitis B vaccine (HepB), dialysis or immunosuppressed patient dosage, 3 dose schedule, for intramuscular use |
| 90743 | Hepatitis B vaccine (HepB), adolescent, 2 dose schedule, for intramuscular use |
| 90744 | Hepatitis B vaccine (HepB), pediatric/adolescent dosage, 3 dose schedule, for intramuscular use |
| 90746 | Hepatitis B vaccine (HepB), adult dosage, 3 dose schedule, for intramuscular use |
| 90747 | Hepatitis B vaccine (HepB), dialysis or immunosuppressed patient dosage, 4 dose schedule, for intramuscular use |
| 90759 | Hepatitis B vaccine (HepB), 3-antigen (s, Pre-S1, Pre-S2), 10 mcg dosage, 3-dose schedule, for intramuscular use |
| G0010 | Administration of hepatitis B vaccine |
For HBV vaccinations, the following ICD-10 diagnosis codes apply:
- Z23
Additional ICD-10 codes may apply. See CMS ICD-10 webpage for individual CRs and the specific ICD-10-CM codes Medicare covers for this service.
HBV Vaccination: Who is Covered/Frequency
- Certain Medicare beneficiaries at intermediate or high risk for contracting hepatitis B. Intermediate and high risk is defined in the CMS IOM Publication 100-02, Medicare Benefit Policy Manual, Chapter 15, Section 50.4.4.2 – Immunizations
- Medicare beneficiaries who are currently positive for antibodies for hepatitis B are not eligible for this benefit
- Scheduled doses required
HBV Vaccination: Other Notes
- Copayment, coinsurance, deductible waived
- Starting 1/1/2024 Medicare pays an additional payment for in-home HBV shot administration under certain circumstances.
COVID-19 Vaccines and Administration
The claim should include the proper billing of the ICD-10. Providers can submit claims using the following example:
- ICD-10: Z23 - Encounter for immunization
- Report the proper date of service
- Report the proper place of service (for Part B claims)
- Get the most current list of billing codes, payment allowances and effective dates at COVID-19 Vaccines and Monoclonal Antibodies
- Medicare pays an additional payment for in-home COVID-19 shot administration under certain circumstances.
Related Content
- CMS IOM Publication 100-02, Medicare Benefit Policy Manual, Chapter 15, Section 50.4.4.2 – Immunizations
- CMS Preventive Services
- MLN® Educational Tool: Medicare Preventive Services
- Fee Schedule Lookup Tool
Revised 2/20/2024