Medicare covers both the costs of the vaccine and its administration by recognized providers. There is no coinsurance or co-payment applied to this benefit and a beneficiary does not have to meet his or her deductible to receive it.
Assignment must be accepted on all vaccine claims and a physician order is not required. If a physician sees a beneficiary for the sole purpose of administering one of these vaccines, an office visit cannot be billed. However, if the beneficiary receives other services which constitute an office visit, then one can be billed.
If both vaccines are administered on the same day, providers are entitled to receive payment for both administration fees. The diagnosis code used for these vaccines and administration is Z23 encounter for immunization. Mass immunizers offer influenza vaccines, pneumococcal vaccines, or both, to groups of individuals, such as from the public or members of a retirement community.
Mass immunizers can be a traditional provider, such as a physician, or a non-traditional provider, such as a drug store, public health clinic or senior citizen home.
CMS created the mass immunizer specialty for those providers that wouldn't otherwise qualify for Medicare enrollment. Centralized billing is an option that allows a mass immunizer to send all its influenza and pneumococcal vaccination claims to a single MAC for payment, regardless of where the vaccination was administered.
