Purpose
To communicate the expansion of the administration at home procedure code to include additional vaccines (i.e., pneumococcal, influenza, hepatitis B) that can be
administered in a home setting.
Background
To
promote vaccination of home-bound individuals, CMS allowed
additional reimbursement for when certain vaccines are provided in the individual's home.
Coverage Statement
MEDICALLY NECESSARY
When pneumococcal, influenza, hepatitis b, and/or COVID-19 vaccines are medically necessary, a home visit for the sole purpose of administration of pneumococcal,
influenza, hepatitis B, and/or COVID-19 vaccines is considered medically necessary and, therefore, covered as a preventive service for individuals who meet either of the following criteria:
- The
individual has difficulty leaving the home to get the vaccine, which
could mean any of these:
- A
condition, due to an illness or injury, that restricts their ability to
leave home without a supportive device or help from a paid or unpaid
caregiver
- A
condition that makes them more susceptible to contracting a disease
- Generally
unable to leave the home, and if they do leave home, it requires a
considerable and taxing effort
- The individual is hard to reach because they have a
disability or face clinical, socioeconomic, or geographical barriers to
getting a vaccine in settings other than their home. These individuals
face challenges that significantly reduce their ability to get vaccinated
outside the home, such as challenges with transportation, communication,
or caregiving.
NOT ELIGIBLE
FOR SEPARATE REIMBURSEMENT
For individuals currently receiving home care services,
administration of pneumococcal, influenza, hepatitis B, and/or COVID-19 vaccines are not eligible for separate
reimbursement consideration from the home care visit.
Coding