The H1N1 virus vaccine will be provided to Medicare beneficiaries as an additional Part B preventive immunization service. Medicare typically pays for only one vaccination per year, unless additional vaccines/doses are medically necessary. The Influenza A (H1 N1) vaccine qualifies as an additional medically necessary vaccine. If the H1 N1 vaccine requires more than one dose, additional doses will also be covered.
Note that Medicare will pay for the vaccine’s administration fee only, not the vaccine itself as these vaccines are being given to providers free of charge. Also, the provider administration payment rate will be the same as that for the seasonal influenza virus vaccine covered under Medicare’s Part B preventive immunization services.
If a Medicare beneficiary receives the H1N1 vaccination from a non-Medicare provider, Medicare will reimburse the beneficiary up to the approved amount for the administration cost only. To receive reimbursement, the beneficiary must submit a CMS Form 1490S to their local Medicare contractor. In California the Part Medicare Part B contractor is Palmetto GBA. The CMS form must be sent to:
- J1 MAC Palmetto GBA, P.O. Box 1051, Augusta, Georgia 30903
Learn more about Medicare’s coverage of H1N1 (PDF) and payment to providers. (Center for Medicare and Medicaid Services (CMS) bulletin)
Read general information on Medicare covered services.
