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Last Modified: 5/31/2022 Location: FL, PR, USVI Business: Part A

Claims reprocessing for outpatient vaccination administrations for 2021 dates of service

Issue
We have identified an issue with the payment rate for HCPCS G0008, G0009 and G0010 for dates of service in 2021. Outpatient claims (Part B of A) reimbursed at the Medicare Physician Fee Schedule (MPFS) were not reimbursed at the correct rate.
Types of bill (TOBs) impacted are 12X, 13X, 22X, 23X, 34X, 72X, 75X and 83X.
Resolution
The rates for 2021, for vaccine administrative services HCPCS G0008 (influenza), G0009 (pneumococcal) and G0010 (hepatitis B), have been corrected and claims are now receiving the correct reimbursement.
Claims previously processed at the incorrect rates have been reprocessed. No provider action is needed. All adjustments have been completed as of May 18, 2022.
Status/date resolved
Closed; all adjustments have been completed as of May 18, 2022.
Provider Action
None
Current processing issues
Here is a link to a table of current processing issues for both Part A and Part B.
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