Payment for Pneumococcal Pneumonia Virus, Influenza Virus,

10.2.2.1 - Payment for Pneumococcal Pneumonia Virus, Influenza Virus, Hepatitis B Virus and COVID-19 Vaccines and Their Administration on Institutional Claims (Rev. 13547; Issued: 12-18-25; Effective: 01-20-26; Implementation: 01-20-26) Payment for Vaccines Payment for these vaccines is as follows: Facility Type of Bill Payment Hospitals, other than Indian Health Service (IHS) Hospitals, IHS CAHs, and Critical Access Hospitals (CAHs) 012x, 013x Reasonable cost IHS Hospitals 012x, 013x 95% of the AWP IHS CAHs 012x, 085x 95% of the AWP CAHs Method I and Method II (other than professional revenue codes) 012x, 085x Reasonable cost Skilled Nursing Facilities 022x, 023x Reasonable cost Home Health Agencies 034x Reasonable cost Hospices 081x, 082x 95% of the AWP Comprehensive Outpatient Rehabilitation Facilities 075x 95% of the AWP Independent Renal Dialysis Facilities (RDFs) 072x 95% of the AWP Hospital-based Renal Dialysis Facilities (RDFs) 072x Reasonable cost Rural Health Clinics (RHCs) 71x 95% of the AWP (effective for dates of service on or after July 1, 2025) then subsequently settled through the cost report. Federally Qualified Health Centers (FQHCs) 77x 95% of the AWP (effective for dates of service on or after July 1, 2025) then subsequently settled through the cost report. Payment for Vaccine Administration Payment for the administration of pneumococcal, influenza, hepatitis B and COVID-19 vaccines is as follows: Facility Type of Bill Payment Hospitals, other than IHS Hospitals, IHS CAHs, and CAHs 012x, 013x Outpatient Prospective Payment System (OPPS) for hospitals subject to OPPS Reasonable cost for hospitals not subject to OPPS IHS Hospitals 012x, 013x MPFS IHS CAHs 012x, 085x MPFS CAHs Method I and Method II (other than professional revenue codes) 012x, 085x Reasonable cost CAHs Method II (Professional Revenue Codes 096x, 097x, 098x) 085x MPFS Skilled Nursing Facilities 022x, 023x MPFS Home Health Agencies 034x OPPS Hospices 081x, 082x MPFS Comprehensive Outpatient Rehabilitation Facilities 075x MPFS Independent RDFs 072x MPFS Hospital-based RDFs 072x Reasonable cost Rural Health Clinics (RHCs) 71x National Fee Schedule for Vaccine Administration (effective for dates of service on or after July 1, 2025) Federally Qualified Health Centers (FQHCs) 77x National Fee Schedule for Vaccine Administration (effective for dates of service on or after July 1, 2025)