Eagle-eyed members tipped NCPA off to a change of vaccine administration reimbursement policies in Medicare Part B fee-for-service that quietly went into effect July 1, 2025. CMS and its Medicare Administrative Contractors (MACs) require modifier 59 “Distinct Procedural Service” be added to the second (or any additional) vaccine administration codes when the COVID-19 vaccine is administered on the same date of service as other Part B vaccines. For example, in addition to the CPT or HCPCS codes for the COVID-19 and flu vaccine products, the claim should include 90480 and G0008-59, respectively, to claim reimbursement for administering the vaccine products. Pharmacies that use a billing intermediary to format prescription claims for the MAC should ask for updated instructions (e.g. a DUR Reason for Service code) on preparing the Rx claim when COVID-19 is one of two or more Part B vaccines administered to a patient on the same date of service.
Pharmacies with denied claims for a vaccine administration code may be able to edit and resubmit those claims through their intermediary or MAC web portal but must do so within 365 days of the date of service. CMS has webpages with Part B vaccine payment information as well as the National Correct Coding Initiative which is the source of the policy change.
