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Medicare Part D Vaccine Billing Requirement Update

Audience: Internal Medicine and Family Practice Physicians and Nurse Practitioners

We remind you that effective February 1, 2023, Excellus BlueCross BlueShield will require the use of the TransactRx billing tool when Medicare Part D vaccines are administered in your office to Medicare Advantage members. You were notified of this update in our bulletin issued November 1, 2022.

TransactRx is an independent company that offers a free, real time, and efficient online tool for providers to bill Part D vaccine claims administered in the office.  The tool also allows providers to determine:

  • If a member has Medicare Part D coverage and the plan in which the member is enrolled
  • How much the provider will be reimbursed for the vaccine. There is no need to bill the administration fee separately because it is included in the Part D vaccine reimbursement

Due to the Inflation Reduction Act, covered Part D vaccines recommended by the Advisory Committee on Immunization Practices are a $0 copay for all Medicare members. A list of the covered Part D vaccines with a $0 copay is available here.

Vaccines for preventive purposes are required to be billed to Part D through TransactRx effective February 1, 2023. These vaccines include, but are not limited to:

  • Diphtheria/Tetanus (Tenivac®)
  • Tetanus, diphtheria toxoid and acellular pertussis (Adacel®, Boostrix®)
  • Zoster vaccine recombinant, adjuvanted (Shingrix®).

Failure to submit claims for Medicare Part D vaccines through TransactRx with dates of service on or after February 1, 2023, will result in a denial and the provider will be held liable. Members cannot be billed for the vaccine.

We strongly encourage you to enroll with TransactRx prior to February 1 to avoid any interruption in reimbursement. To learn more, enroll, or to register for a TransactRx demonstration free of charge, go to

If you opt not to use the tool, we recommend that you direct our Medicare Advantage members to obtain Part D vaccines at their local in-network pharmacy.

Please share this information with your billing office and anyone in your practice who needs to be aware.  If you have questions, contact your Provider Relations representative.

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