Page 65 - Medicare Benefit Policy Manual

Effective for services furnished on or after September 1,
1984, P.L. 98-369 provides coverage under Part B for
hepatitis B vaccine and its administration, furnished to a
Medicare beneficiary who is at high or intermediate risk of
contracting hepatitis B. High- risk groups currently identified
include (see exception below):

• ESRD patients;

• Hemophiliacs who receive Factor VIII or IX concentrates;

• Clients of institutions for the mentally retarded;

• Persons who live in the same household as a Hepatitis B Virus (HBV)
carrier;

• Homosexual men;

• Illicit injectable drug users; and

• Persons diagnosed with diabetes mellitus

Intermediate risk groups currently identified include:

• Staff in institutions for the mentally retarded; and

• Workers in health care professions who have
frequent contact with blood or blood-derived
body fluids during routine work.

EXCEPTION: Persons in both of the above-listed groups in
paragraph B, would not be considered at high or intermediate
risk of contracting hepatitis B, however, if there were
laboratory evidence positive for antibodies to hepatitis B.
(ESRD patients are routinely tested for hepatitis B antibodies
as part of their continuing monitoring and therapy.)

For Medicare program purposes, the vaccine may be
administered upon the order of a doctor of medicine or
osteopathy, by a doctor of medicine or osteopathy, or by home
health agencies, skilled nursing facilities, ESRD facilities,
hospital outpatient departments, and persons recognized under
the incident to physicians’ services provision of law.

A charge separate from the ESRD composite rate will be