I want to begin providing vaccines for my adult patients but reimbursement for these vaccines is confusing. Can you provide guidance?

All commercial insurance plans compliant with the Affordable Care Act (ACA) should cover vaccines listed on the CDC’s recommended schedules for vaccines for children and adults without any cost-sharing (e.g., no deductible or copay) when given by in-network providers.

The Inflation Reduction Act (IRA) of 2022, which was fully enacted during 2023, substantially reduced cost-related barriers to vaccination for adults. The law eliminated cost-sharing for ACIP-recommended vaccination of all adults covered by traditional Medicaid and Medicaid expansion plans, as well as adults with Medicare Part D.  More information about the ACA and IRA legislation impact on vaccine payment is available in this pdf report published by Avalere on October 2, 2023:  https://avalere.com/wp-content/uploads/2023/10/Guide-to-Vaccine-Coverage-Policies.pdf.

The National Adult and Influenza Immunization Summit (NAIIS) has created a web section with resources on billing and coding for adult vaccinations at www.izsummitpartners.org/naiis-workgroups/access-provider-workgroup/coding-and-billing.