The Influenza vaccine for 2009 is reimbursed on reasonable cost, while the Influenza administration rate is reimbursed on the wage adjusted outpatient prospective payment system (OPPS) reimbursement rate.
The OPPS reimbursement rate for 2009 is $24.89. The rate is wage adjusted where the labor portion is 60% and non-labor portion is 40%.
The H1N1 vaccine is to be provided at no charge to providers therefore, there will be no provider reimbursement for the H1N1 vaccine. Medicare will reimburse providers for the administration of the H1N1 vaccine at the same rate as the influenza vaccine administration rate. Home health providers will be reimbursed at the wage adjusted amount for $24.89.
For example, in 2009, the national unadjusted payment rate is $24.89. If the wage index for the applicable CBSA is .99, then the payment to the HHA would be $24.74
$24.89*.6=$14.934 (the portion to be wage adjusted);
$14.934*.99 (the wage index) =$14.78466 (the wage adjusted portion of the payment)
$14.78466+$9.956 (the 40% of the national unadjusted payment that is not wage adjusted) = $24.74 (after rounding)).
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