Medicare

[PMBS]

I know that Medicare does not pay for the Zostovax shot, however a patient came in and had the doctor administer the shot for him.  Can I bill Medicare for the administration of the shot and is there a specific diagnosis code I should use?   I already tried billing Medicare for the admin portion and used dx code V05.8 and they denied it.

Thanks

MR

[PMRNC]

No, this vaccine is only covered through Part D.
Here is a link to an MLN memo that covers this very thing, you have to scroll way down to bottom to get the specifics on the Zostavax
http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0678.pdf

Assuming since you said it was billed and denied already, you can still bill the beneficiary because it's a non-covered service and an ABN was NOT required. You can inform the provider let patient's know about how Part D will cover this.

Linda Walker
PMRNC
www.billerswebsite.com