CMS Pub. 100-04, ch. 18, § 10.2.3

Hospices

(Rev. 11355; Issued:04-14-22; Effective:05-16-22; Implementation:05-16-22)

The following provides billing instructions for Home Health Agencies (HHAs) in various

situations:

Where the sole purpose for an HHA visit is to administer a vaccine (influenza virus,

pneumococcal, hepatitis B or COVID-19), Medicare will not pay for a skilled nursing visit

by an HHA nurse under the HHA benefit. However, the vaccine and its administration are

covered under the vaccine benefit. The administration should include charges only for the

supplies being used and the cost of the injection. Medicare does not allow HHAs to charge

for travel time or other expenses (e.g., gasoline). In this situation, the HHA bills under bill

type 034x and reports revenue code 0636 along with the appropriate HCPCS code for the

vaccine and revenue code 0771 along with the appropriate HCPCS code for the

administration.

NOTE: A separate bill is not allowed for the visit.

If a vaccine (influenza virus, pneumococcal, hepatitis B, or COVID-19) is administered

during the course of an otherwise covered home health visit (e.g., to perform wound care),

the visit would be covered as normal but the HHA must not include the vaccine or its

administration in their visit charge. In this case, the HHA is entitled to payment for the

vaccine and its administration under the vaccine benefit. In this situation, the HHA bills

under bill type 034x and reports revenue code 0636 along with the appropriate HCPCS code

for the vaccine and revenue code 0771 along with the appropriate HCPCS code for the

administration.

NOTE: A separate bill is required for the visit

Where a beneficiary does not meet the eligibility criteria for home health coverage, a home

health nurse may be paid for the vaccine (influenza virus, pneumococcal, hepatitis B or

COVID-19) and its administration. No skilled nursing visit charge is billable.

Administration of the services should include charges only for the supplies being used and

the cost of the injection. Medicare does not pay for travel time or other expenses (e.g.,

gasoline). In this situation, the HHA bills under bill type 034x and reports revenue code

0636 along with the appropriate HCPCS code for the vaccine and revenue code 0771 along

with the appropriate HCPCS code for the administration.

If a beneficiary meets the eligibility criteria for coverage, but his or her spouse does not, and

the spouse wants an injection the same time as a nursing visit, HHAs bill in accordance

with the last bullet point above.

The following provides billing instructions for hospices:

Hospices can provide the influenza virus, pneumococcal, hepatitis B and COVID-19 vaccines to

those beneficiaries who request them, including those who have elected the hospice benefit. These

services may be covered when furnished by the hospice.

For dates of service before October 1, 2016, services for vaccines and their administration provided

by a hospice should be billed on a professional claim to the local MAC. Payment is made using the

same methodology as if they were a supplier. Hospices that do not have a supplier number should

contact their MAC to obtain one in order to bill for these benefits.

For dates of service on or after October 1, 2016, services for vaccines and their administration

provided by a hospice may be billed on an institutional claim.