Vaccination and Immunization

Medicare Part B always covers 3 routine immunizations:

Pneumococcal pneumonia (PPV)
Influenza (the flu)
Hepatitis B (if you are at medium to high risk)

All vaccines other than those for the flu, pneumonia or hepatitis B are covered under Medicare Part D.

Part B will cover other immunizations only if you have been exposed to a dangerous virus or disease. For example, if you step on a rusty nail, Medicare will cover a tetanus shot; if you are bitten by a dog, Medicare will cover your rabies shots.

Immunization after exposure to disease

Hepatitis A (CPT codes 90632, 90633, 90634)
Immune globulin subject to the requirements of L30147, Immune Globulins
Rabies prophylaxis (CPT codes 90675, 90676)
Tetanus and diphtheria toxoids (CPT codes 90702, 90714, 90715)

Medicare Covered for Tetanus Vaccine

Covered when given for an acute injury to a person who is incompletely immunized.

90702 Diphtheria and tetanus toxoids adsorbed (DT), >7 years

90714 Tetanus and diphtheria toxoids adsorbed (Td), 7 years or older

90715 Tetanus, diphtheria toxoids, and acellular pertussis vaccine (Tdap), 7 years or older

Medicare Covered for Rabies Vaccine

Rabies is a disease that is carried by animals and transmitted by a bite or scratch. When administering a rabies vaccine to a human who has had an encounter with an animal that is at high risk for rabies, 90675 should be billed with the appropriate ICD-10 diagnosis code for the exposure.

90675 Rabies vaccine, for intramuscular use

90676 Rabies vaccine, for intradermal use

Useful Immunization Resources

Centers for Disease Control and Prevention
The CDC Vaccine Price Lists

The Immunization Action Coalition (IAC)
Influenza Vaccine Products for the 2017–2018

American Academy of Pediatrics
Commonly Administered Pediatric Vaccines

Medicare Interactive
Medicare coverage of vaccines and immunizations