Traditional MedicareBilling CodesMedium impact
Immunizations for Dual Eligible Participants
Missouri Medicaid (MO HealthNet)·MO · Family Medicine, Internal Medicine, General Practice +2 more·Provider Notice
Effective date
Oct 5, 2017
We identified it
Jun 20, 2026
Summary
For dual eligible participants (Medicare + Medicaid), providers must now bill Medicare first for all vaccines instead of MO HealthNet. Part B covers pneumococcal, influenza, and Hepatitis B vaccines, while other vaccines are covered under Medicare Part D and should be dispensed at pharmacies when providers cannot bill Part D directly.
Action Required
Immediately: Billing team must update vaccine billing workflow for dual eligible participants to bill Medicare first instead of MO HealthNet. Update billing system rules to route pneumococcal, influenza, and Hepatitis B vaccines to Medicare Part B. For other vaccines not covered by Part B, refer patients to pharmacies for Part D coverage when direct Part D billing is unavailable.