CMS updated its vaccine pricing information for Part B vaccines on its vaccine pricing webpage. The pricing information for the 2025-26 influenza vaccine (95 percent of AWP) as well as the geographically adjusted administration fee (approximately $33) and in-home additional payment (approximately $40) are in effect as of Aug. 1, 2025. The updated pricing information for the 2025-26 COVID-19 vaccine has not yet been posted. Pharmacies may be able to obtain additional information from their Medicare Administrative Contractor or Part B claims intermediary.
Make sure to review your vaccine billing practices. Your reimbursement can be impacted by whether you bill to Medicare Part B, Part D, or the patient's medical benefit under their Medicare Advantage plan. It may be beneficial to bill for the product under one benefit and the administration under another.
Want more billing tips like this? Register for our Oct. 17 workshop, "The New Route to Reimbursement: A Roadmap From Application to Activation." It's one of our pre-convention offerings in the days before the 2025 NCPA Annual Convention in New Orleans, Oct. 18-21.
