Ama Policy

Appropriate Reimbursements and Carve-outs for Vaccines D-440.981

Fee Schedules

Our AMA will: (1) continue to work with the Centers for Medicare and Medicaid Services (CMS) and provide comment on the Medicare Program payment policy for vaccine services; (2) continue to pursue adequate reimbursement for vaccines and their administration from all public and private payers; (3) encourage health plans to recognize that physicians incur costs associated with the procurement, storage and administration of vaccines that may be beyond the average wholesale price of any one particular vaccine; (4) seek legislation mandating that health insurance companies in applicable states either adequately pay for vaccines recommended by the Advisory Committee on Immunization Practices, or clearly state in large bold font in their notices to patients and businesses that they do not follow the federal advisory body on vaccine recommendations, the Advisory Committee on Immunization Practices; and (5) advocate that a physician’s office can bill Medicare for all vaccines administered to Medicare beneficiaries and that the patient shall only pay the applicable copay to prevent fragmentation of care.

Policy Timeline

BOT Rep. 20, A-03 Reaffirmation A-07 Res. 128, A-09 Reaffirmation I-10 Reaffirmed: Res. 807, I-11 Appended: Res. 217, A-19 Reaffirmed: CMS Rep. 3, I-20 Reaffirmed: Res. 408, I-21