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Important information about payment of Part D vaccine claims, starting Jan. 1, 2017

11/29/2016

Starting Jan. 1, 2017, Medicare Part D vaccines must be submitted under the member’s Part D prescription drug benefit — not under the member’s Part B medical benefit.

Part D vaccines include, but are not limited to the following:

  • Human papillomavirus (HPV)
  • Measles, Mumps and Rubella (MMR)
  • Meningitis
  • Shingles
  • Varicella

This means we will not pay claims for Part D vaccines administered in a physician’s office and submitted under the Part B medical benefit. This is consistent with guidance from the Centers for Medicare & Medicaid Services (CMS).

Register on TransactRx for free
If you wish to continue administering these vaccines in your office, please use TransactRx, an electronic claims adjudication portal that allows physicians to electronically submit vaccine claims under their patient’s Part D benefit. TransactRx will send payments directly to you twice a month for your submitted claims.

TransactRx can also help your patients minimize their upfront, out-of-pocket costs for vaccines. Go to www.transactrx.com/physician-vaccine-billing for details.

If you do not want to submit vaccine claims through TransactRx, please send your patients to the pharmacy to get the vaccines.