Medicare hikes pay for pneumonia shots

The administration has worked to remove barriers to increasing immunization rates.

By Markian Hawryluk, AMNews staff. Sept. 8, 2003.

Washington -- In a five-line paragraph posted on its Web site, the Centers for Medicare & Medicaid Services announced in late August that the Medicare Part B payment for pneumococcal vaccine would increase to $18.62 effective Oct. 1.

But even the few physicians who have seen the announcement may not realize the payment increase is only the latest in a long series of steps the Bush administration has taken to help reduce barriers to immunization for both pneumonia and influenza and to reach its goal of nearly universal vaccination for at-risk beneficiaries.

When coupled with a 94% increase in March in payment for the administration of pneumococcal vaccine, the change will mean physicians will receive average total reimbursement of $26.58 after Oct. 1 for providing the vaccine, up from $17.08 at the start of the year.

And CMS has moved to make immunization easier in clinics and other health facilities. The agency is expected to issue a new regulation on Oct. 2 allowing hospitals, nursing homes and home health agencies to use standing orders to immunize their patients. The rule will authorize pharmacists and nurses to administer vaccinations under a institution- or physician-approved protocol without requiring physicians to first examine the patients.

Additionally, CMS indicated that small physician practices and facilities that are otherwise exempt from Health Insurance Portability and Accountability Act electronic transaction standards could electronically submit a single bill for all vaccinations without triggering HIPAA rules.