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2026 influenza, pneumococcal, and hepatitis B vaccine reimbursement

Vaccine fees

Please refer to the Medicare Preventive Services Educational Tool for policy and frequency guidelines.

Payment allowances for codes for which products have not yet been approved will be provided when the products have been approved, and pricing information becomes available to CMS.

Influenza (flu) vaccine

The annual influenza vaccine season runs from August 1 through July 31 of the following year.

Payment allowances and effective dates for the 2025-2026 flu season is available on the CMS Vaccines Pricing page. Once on this page, click the "Seasonal Influenza Vaccine Pricing" and select "2025 - 2026 Flu Season Pricing Resources."

Pneumococcal (PPV) and hepatitis B vaccines

Payment allowances and effective dates for the PPV and hepatitis B vaccines are available on the ASP Drug Pricing page. Payment allowances for codes for which products have not yet been approved will be provided when the products have been approved, and pricing information becomes available to CMS.

Administration fees

The 2026 influenza, pneumococcal, and hepatitis B vaccine administration reimbursement rate is identical.

  • G0008 - administration of influenza virus vaccine
  • G0009 - administration of pneumococcal vaccine
  • G0010 - administration of hepatitis B vaccine
  • M0201 - administration of vaccine in the home

For claims with dates of service on or after January 1 through December 31, the national payment rate for HCPCS codes G0008, G0009, and G0010 is $34.62, M0201 is $40.98.
CMS has established codes and fees based on the geographically adjusted payment allowances for these codes.

Note: Centralized billers cannot bill for G0010. Please be sure to review the guidelines for centralized billers if you have questions about proper billing.

References