2025 influenza, pneumococcal, and hepatitis B vaccine reimbursement
Vaccine fees
Please refer to the Medicare Preventive Services Educational Tool for policy and frequency guidelines.
Payment allowances for codes for which products have not yet been approved will be provided when the products have been approved and pricing information becomes available to CMS.
Influenza (flu) vaccine
The annual influenza vaccine season runs from August 1 through July 31 of the following year.
Payment allowances and effective dates for the 2025-2026 flu season is available on the CMS Seasonal Influenza Vaccines Pricing page.
Once on this page, click "Seasonal Flu Vaccines."
Pneumococcal (PPV) and hepatitis B vaccines
Payment allowances and effective dates for the PPV and hepatitis B vaccines are available on the ASP Drug Pricing page.
Payment allowances for codes for which products have not yet been approved will be provided when the products have been approved and pricing information becomes available to CMS.
Administration fees
The 2025 influenza, pneumococcal, and hepatitis B vaccine administration reimbursement rate is identical.
- G0008 - administration of influenza virus vaccine
- G0009 - administration of pneumococcal vaccine
- G0010 - administration of hepatitis B vaccine
- M0201 - administration of vaccine in the home
For claims with dates of service on or after January 1 through December 31, the national payment rate for HCPCS codes G0008, G0009, and G0010 is $33.71, M0201 is $39.90.
CMS has established codes and fees based on the geographically adjusted payment allowances for these codes.
- The geographically adjusted payment rates are available by reviewing the 2025 Geographically Adjusted Payment Rates for Influenza, Pneumococcal, Hepatitis B and COVID-19 Vaccine Administration & In-Home Additional Payment (ZIP) [For claims with dates of service 1/1/2025-12/31/2025]
References
- 2025 Geographically-Adjusted Payment Rates for Influenza, Pneumococcal, Hepatitis B and COVID-19 Vaccine Administration & In-Home Additional Payment (ZIP) (For claims with dates of service 1/1/2025-12/31/2025)
- 2024 Locality-Adjusted Payment Rates for Influenza, Pneumococcal and Hepatitis B Vaccine Administration-For claims with dates of service 1/1/2024-12/31/2024(ZIP)
- 2023 Locality-Adjusted Payment Rates for Influenza, Pneumococcal and Hepatitis B Vaccine Administration - For claims with dates of service 1/1/2023-12/31/2023 (ZIP)
- In-Home Vaccine Administration: Additional Payment