Medicare will reimburse doctors for the cost of diagnosing and treating suspected vaccine-related adverse effects, according to a new Centers for Medicare & Medicaid Services (CMS) policy announced last week and published today in the Federal Register.
Under the rule, CMS will introduce billing code G0576 to reimburse physicians and other eligible Medicare providers for every 15 minutes of qualifying work evaluating, diagnosing, treating or counseling patients with suspected vaccine-related adverse reactions.
The reimbursement payment will be in addition to what Medicare already pays for a standard office visit.
Doctors can qualify for reimbursement by documenting when the suspected adverse reaction occurred in relation to vaccination, evaluating other possible causes of the patient’s symptoms and maintaining supporting medical records.
A CMS spokesperson told The Defender that reimbursement would not depend on a final determination that a vaccine caused the reported symptoms.
“Physicians will not be paid based on whether a report is ultimately determined to be related to a vaccine, nor would reimbursement change the standard for evaluating those reports,” the spokesperson said.
CMS framed the new code as a way to support the Trump administration’s Make America Healthy Again (MAHA) initiative.
“Medicare should reward clinicians for keeping people healthy,” U.S. Health Secretary Robert F. Kennedy Jr. said in a statement.
Last month, the U.S. Department of Health and Human Services (HHS) referenced the initiative when it launched a federal Vaccine Injury Center. At the time, HHS officials said doctors would be reimbursed for time spent reporting suspected vaccine injuries to the Vaccine Adverse Event Reporting System (VAERS).
However, the final rule does not explicitly authorize or exclude reimbursement for submitting VAERS reports, leaving it unclear whether physicians can bill for time spent completing and submitting the reports.
CMS did not answer a follow-up request by press time seeking clarification on whether G0576 covers the time spent completing and submitting VAERS reports.
The code, which will also apply to telehealth visits, takes effect Jan. 1, 2027.
