Hep B for Medicare

[Missouri Public Health Association]

Is there a special DX or something I am missing? Medicare B is denying Hep B vaccine.

Thanks

[Missouri Public Health Association]

I wonder if there is an add on diagnosis code for a high risk condition if trying to go through Part B not D. I thought they would only cover Hep B if the patient is high risk.

[Missouri Public Health Association]

It is my understanding that Hep B is only covered by Medicare Part B for high risk such as being on kidney dialysis. https://www.cms.gov/medicare/prevention/prevntiongeninfo/medicare-preventive-services/mps-quickreferencechart-1.html#HEP_B

Medicare Covers
Certain patients with Medicare Part B who are at intermediate or high risk for contracting hepatitis B

[Missouri Public Health Association]

Yes- I knew it was for high risk patients…. the denial states not covered when performed by a provider of this specialty.

So basically, we can bill Medicare Part B for Flu, Pneumonia, and Covid only?

All others run through Transact RX?

Would Hep B be covered though Transact RX, if they had Part D Coverage?

Thank you all for your help!

[Missouri Public Health Association]

When using TransactRX, most Hep B vaccines require a prior authorization or you will receive a REJECTED status. I am usually able to call the Part D plan and obtain the prior auth at the time of service. One time I did have to wait 24 hours for the decision to be faxed.

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