Flu Shot Charges

March 1, 2005

We started to offer the flu vaccine to serve the community. The cost is $20 cash-only; we don't do any billing. Since many of these patients have Medicare, is this allowed? People will pay $20, but Medicare may not pay that much.

Question: We started to offer the flu vaccine to serve the community. The cost is $20 cash-only; we don't do any billing. Since many of these patients have Medicare, is this allowed? People will pay $20, but Medicare may not pay that much.

Answer: If flu shots are a covered service, you have to bill for them (otherwise you are essentially requiring the patient to pay for the service twice). If the flu shot is not a covered service, you can provide it as a self-pay or cash service.

Medicare pays for flu shots once every flu season. The shot can be given within the same calendar year and still be reimbursed. For example, a patient can have a flu shot in January 2004 and again in November 2004.

Be aware that you should not offer services to anyone for less than Medicare rates. You don't want to be seen as offering illegal incentives to patients.