Medicare announces influenza vaccine payment rates for 2021-2022

The Centers for Medicare & Medicaid Services (CMS) has announced the Medicare Part B payment allowances for various influenza vaccines for the 2021-2022 flu season. Effective dates, available on the CMS pricing webpage, vary somewhat by vaccine, but are generally from August 2021 through July 2022. The payment allowances range from about $10 to $66, depending on brand and formulation (CMS will add more if other influenza vaccines are approved by the Food and Drug Administration).  

The Medicare Part B payment allowances for flu shots represent 95% of the average wholesale price, except for vaccines given in a:

• Hospital outpatient department,
• Rural Health Clinic,
• Federally Qualified Health Center.

At those three sites, Medicare bases payment on reasonable cost.

As usual, annual Part B deductible and coinsurance amounts don’t apply, and all physicians, non-physician practitioners, and suppliers who give the flu shot must take assignment on the claim for the shot.

Note that Medicare administrative contractors (MACs) will reprocess paid claims for the current flu season (which began Aug. 1) if they used payment allowances other than those on the CMS pricing webpage. They should complete the reprocessing of these claims by Nov. 1. Please contact your MAC for more information.  

— Kent Moore, Senior Strategist for Physician Payment