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MPhA  officers are, from left, Waymon Tigrett, treasurer; Eddie Rutherford, at-large member; Wynn Sanders, president; Ed White, vice president; Robert Salmon, president elect; and Kimsey Cooper O'Neal, at-large member.

Pharmacy Billing for Influenza and Pneumonia

In the MS Medicaid Pharmacy program, influenza and pneumonia immunizations are covered services for Medicaid beneficiaries ages 19 and older who are not residents of long-term care facilities. These are the only vaccines/immunizations available via the Pharmacy Program. As with other pharmacy services, a hard copy prescription must be on file. Immunizations provided from a credentialed pharmacist will count against the service limits and co-payments are applicable.

If a beneficiary has Medicare and Medicaid, Medicare is to be billed first. Medicare provides coverage for the flu vaccine and its administration. Influenza vaccination is a covered Part B benefit. Note that influenza vaccine is NOT a Part D covered drug.

Influenza and pneumococcal vaccines will be reimbursed by the DOM for residents with a payment source of Medicaid only in nursing facilities. The facilities may have the provider come to the facility and administer the injections or may send a resident to the provider’s office for the injection. The provider may bill and be reimbursed by Medicaid, or the facility may purchase the vaccine, administer the injection, and claim the cost of the vaccine in the Medicaid cost report for Medicaid only residents. Facilities cannot claim the cost of the vaccine in the Medicaid cost report for Medicare patients. All immunizations for children age 18 and younger must be handled through the Vaccines for Children Program (VFC).

For additional information regarding immunizations and Medicaid policies, refer to Medicaid’s Provider Manual, Section 77, Immunization