Traditional MedicareBilling CodesHigh impact
Immunizations for Dual Eligible Participants (Update)
Missouri Medicaid (MO HealthNet)·MO · Family Medicine, Internal Medicine, Pediatrics +1 more·Provider Notice
Effective date
Jul 14, 2022
We identified it
Jun 20, 2026
Summary
For dual eligible participants, providers must now bill Medicare first for all vaccines instead of Medicaid. Part B covers pneumococcal, influenza, and Hepatitis B vaccines, while Part D covers others like Tdap and Zoster which should be dispensed at pharmacies when Part D cannot be billed directly.
Action Required
Immediately: Billing team must update vaccine billing workflow for dual eligible participants to bill Medicare first instead of Medicaid. Configure system to route pneumococcal, influenza, and Hepatitis B vaccines to Medicare Part B. For Tdap, Zoster, and other Part D vaccines, refer patients to pharmacy when Part D plan cannot be billed directly. Update staff training on dual eligible vaccine billing hierarchy.