20 PRESCRIPTION DRUG COVERAGE
20.7 Vaccines Covered Under Either Part B or Part D Benefit Coverage
Vaccines administered directly related to the treatment of an injury or direct exposure to a disease or condition would be covered under Part B. Vaccines administered for prevention of an illness and not covered under Medicare Part B (influenza or pneumococcal) would be covered under Part D. Vaccines that may be Part B or Part D are:
For reimbursement of a vaccine and vaccine administration that could be either Part B or Part D, indicate the reason for immunization (injury and/or direct disease exposure or prevention of an illness) on a CMS 1500 (08-05) claims form and submit to:
Providers who have a supply and administer the vaccine in their office should collect the member’s copay at time of service and submit the claim for the vaccine and administration on a CMS 1500 (08-05) form to:
Amerigroup
Attn: Claims Department
P.O. Box 61010
Virginia Beach, VA 23466-1010
Additional information can be found on the CMS website under the Medicare Learning Network General Information page at https://www.cms.gov.