Traditional MedicareReimbursementMedium impact
Newsletter Vol. 4, No. 46
New Jersey Medicaid·NJ · Family Medicine, Internal Medicine, General Practice +2 more·Provider Notice
We identified it
Jun 20, 2026
Summary
For dual-eligible Medicare/Medicaid patients, influenza vaccines are now reimbursed at 100% by Medicare, requiring providers to bill Medicare intermediary first instead of Medicaid. Physicians cannot bill for vaccine administration when facility staff administer the injection in healthcare facilities.
Action Required
Immediately: Update billing procedures for dual-eligible Medicare/Medicaid patients receiving influenza vaccines - bill Medicare intermediary first at 100% reimbursement rate before billing Medicaid. Ensure physicians do not bill for vaccine administration when facility staff administer injections in healthcare facilities. Contact Medicaid District Office Pharmaceutical Consultant for specific billing procedures if unfamiliar with long-term care vaccine billing methods.