CMS expands hepatitis B vaccination coverage, authorizes roster billing
CMS recently expanded coverage of hepatitis B vaccines and their administration, enabling mass immunizers to submit these claims under the same roster billing system used for the flu, pneumococcal, and COVID-19 vaccines.
The agency revised 42 CFR § 410.63(a)(2) to expand the list of individuals who are at a high or intermediate risk of contracting hepatitis B and qualify for Part B coverage. Effective January 1, 2025, patients who have not previously received a completed hepatitis B vaccination series or have an unknown vaccination history also fall within the intermediate-risk group.
CMS clarified that a doctor’s order is no longer necessary to administer the hepatitis B vaccine under Part B. Revenue integrity professionals can find more information on place of service codes, simplified roster claims, and more in Medicare Claims Processing Transmittal 13091.
CMS pays roster bills for hepatitis B vaccine and administration claims in the same way it does for other Part B vaccines. The products are paid at 95% of their average wholesale price and the administration is paid according to the Part B vaccine administration fee schedule.
Organizations that administer hepatitis B vaccines must ensure staff are aware of the updated coverage criteria, and mass immunizers should review the related roster billing processes. Learn more about roster billing here.
Editor’s note: Find more NAHRI resources on vaccine coding and billing here.