Medicare Claims Processing Manual (Pub. 100-04), Ch. 18 § 10.1.2
Influenza Virus Vaccine
10.1.2 - Influenza Virus Vaccine
(Rev. 2253, Issued: 07-08-11, Effective: 08-08-11, Implementation: 08-08-11)
Effective for services furnished on or after May 1, 1993, the influenza virus vaccine and its
administration is covered when furnished in compliance with any applicable State law.
Typically, this vaccine is administered once a flu season. Medicare does not require for
coverage purposes that a doctor of medicine or osteopathy order the vaccine. Therefore, the
beneficiary may receive the vaccine upon request without a physician’s order and without
physician supervision. Since there is no yearly limit, A/B MACs (A) and (B) determine
whether such services are reasonable and allow payment if appropriate.
See Pub. 100-02, Medicare Benefit Policy Manual, Chapter 15, Section 50.4.4.2 for
additional coverage requirements for influenza virus vaccine.