CMS Pub. 100-04, ch. 18, § 10.2.4.1

Hepatitis B vaccine and its administration (including staff time and supplies such as syringes) are

paid to ESRD facilities in addition to, and separately from, the dialysis composite rate payment.

Payment for the hepatitis B vaccine for ESRD patients follows the same general principles that are

applicable to any injectable drug or biological. Hospital-based facilities are paid for their direct

and indirect costs on a reasonable cost basis, and independent facilities are paid the lower of the

actual charge or 95 percent of the AWP. The allowance for an injectable is based on the cost of the

injectable and any supplies used for administration, plus a maximum $2 for the labor involved, if

the facility’s staff administers the vaccine. In addition, the MAC (Part A) makes an appropriate

allowance for facility overhead.

Where the vaccine is administered in a hospital outpatient department for home dialysis patients or

for patients with chronic renal failure (but not yet on dialysis), payment is on a reasonable cost

basis. Outpatient hospital vaccines for non-dialysis purposes are paid under hospital outpatient

PPS rules.