• Billing & Reimbursement

I want to begin providing vaccines for my adult patients but reimbursement for these vaccines is confusing. Can you provide guidance?

In 2017, the Immunization Action Coalition revised its comprehensive 142-page guide titled Vaccinating Adults: A Step-by-Step Guide. The guide was written to assist medical practices to improve their adult vaccination services. Two of the chapters (7A and 7B) address financial considerations and provide guidance on how to obtain reimbursement for adult vaccines. The guide is available free of charge on the Immunize.org website at www.immunize.org/guide. In addition, the National Adult and Influenza Immunization Summit has created a web section on this topic at www.izsummitpartners.org/naiis-workgroups/access-provider-workgroup/coding-and-billing.

The Inflation Reduction Act of 2022, once fully enacted during 2023, will substantially reduce cost-related barriers to vaccination for adults. The law eliminates cost-sharing for ACIP-recommended vaccination of all adults covered by Medicaid and Medicaid expansion plans, as well as adults with Medicare Part D. It also provides for enhanced federal reimbursement for immunizing providers. Details about implementation are forthcoming at the time of this update.

Last reviewed: August 26, 2022

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