Back To News Home Item 11 of 33 in this Category Does Medicare Cover Vitamin B-12 Injections (Shots)? Published on 2013-03-20 19:04:11Category: General Medicare In specific cases, Medicare will cover Vitamin B-12 injections (as noted in the Medicare benefits manual). Medicare Benefit Policy Manual Chapter 7 - Home Health Services (Rev. 208, 05-11-15) 40.1.2.4 - Administration of Medications (Rev. 1, 10-01-03) A3-3118.1.B.4, HHA-205.1.B.4 Although drugs and biologicals are specifically excluded from coverage by the statute (§1861(m)(5) of the Act, the services of a nurse that are required to administer the medications safely and effectively may be covered if they are reasonable and necessary to the treatment of the illness or injury. Intravenous, intramuscular, or subcutaneous injections and infusions, and hypodermoclysis or intravenous feedings require the skills of a licensed nurse to be performed (or taught) safely and effectively. Where these services are reasonable and necessary to treat the illness or injury, they may be covered.
For these services to be reasonable and necessary, the medication being administered must be accepted as safe and effective treatment of the patient's illness or injury, and there must be a medical reason that the medication cannot be taken orally. Moreover, the frequency and duration of the administration of the medication must be within accepted standards of medical practice, or there must be a valid explanation regarding the extenuating circumstances to justify the need for the additional injections. 1. Vitamin B-12 injections are considered specific therapy only for the following conditions: • Specified anemias: pernicious anemia, megaloblastic anemias, macrocytic anemias, fish tapeworm anemia; Specified gastrointestinal disorders: gastrectomy, malabsorption syndromes such as sprue and idiopathic steatorrhea, surgical and mechanical disorders such as resection of the small intestine, strictures, anastomosis and blind loop syndrome, and • Certain neuropathies: posterolateral sclerosis, other neuropathies associated with pernicious anemia, during the acute phase or acute exacerbation of aneuropathy due to malnutrition and alcoholism.
For a patient with pernicious anemia caused by a B-12 deficiency, intramuscular or subcutaneous injection of vitamin B-12 at a dose of from 100 to 1000 micrograms no more frequently than once monthly is the accepted reasonable and necessary dosage schedule for maintenance treatment. More frequent injections would be appropriate in the initial or acute phaseof the disease until it has been determined through laboratory tests that the patient can be sustained on a maintenance dose. The excerpt below is from Medicare Benefit Policy Manual, Chapter 7 - Home Health Services. Section 40.1.2.4 -Administration of Medications(Rev. 1, 10-01-03)A3-3118.1.B.4, HHA-205.1.B.4 (page 48): Vitamin B-12 injections are considered specific therapy only for the following conditions: Specified anemias: pernicious anemia, megaloblastic anemias, macrocytic anemias, fish tapeworm anemia; Specified gastrointestinal disorders: gastrectomy, malabsorption syndromes such as sprue and idiopathic steatorrhea, surgical and mechanical disorders such as resection of the small intestine, strictures, anastomosis and blind loop syndrome, and
Certain neuropathies: posterolateral sclerosis, other neuropathies associated with pernicious anemia, during the acute phase or acute exacerbation of a neuropathy due to malnutrition and alcoholism.More frequent injections would be appropriate in the initial or acute phase of the disease until it has been determined through laboratory tests that the patient can be sustained on a maintenance dose. Browse 2017 Medicare Part D prescription drug plans Browse 2017 Medicare Advantage plans (MA-PD) Click here to receive an email when the 2018 Medicare plan information becomes available. Sign-up for our Medicare Part D Newsletter.Click here to let us know. Back To News Home Blog 11 of 33 in this Category Click the +1 button if you have found this page useful:Error: Page Not Found We're sorry, but there is no www.cms.gov web page that matches your entry. You may have been directed here because: The address you typed contains a typo; The requested page may have expired or;
The requested page may have been moved. Please try one of the following resources: Regulations & Guidance Information Note: If you were using a bookmark, please reset it once you find the correct page.Vitamin B12 shots are crucial if you’re diagnosed with extremely low levels of vitamin B12, but they can be expensive. Some medical insurance plans cover the costs of vitamin B12 injections, but only if you qualify. Even if you’re approved, you may not be getting the right dosage to relieve some of the ailments that come with even mild vitamin B12 deficiency. Intramuscular vitamin B12 shots require the services of a licensed nurse, and to get your fill, your best bet is to apply for coverage from your medical insurance plan. Unfortunately, healthcare plans such as Cigna, Aetna, and Blue Cross, in addition to Medicare, can make it difficult for you to get enough B12. Their mission is to prevent death from pernicious anemia, and they do that reasonably well…
Still, there are a host of health problems that don’t go away with minimum vitamin B12 shots; constant fatigue, brain fog, and depression can continue if you’re not getting enough vitamin B12 from your healthcare provider. Aetna will pay for vitamin B12 injections if you suffer from: Also, if you have vitamin B12 deficiency caused by medications such as metformin for diabetes, then you may be able to get your insurance to pay for vitamin B12 shots. But no mention is made of vitamin B12 supplements in relation to symptoms of fatigue, muscle pain, anxiety, depression, or dizziness that occur when vitamin B12 levels are even marginally low, in people who are not diagnosed with anemia. Also, children with autism are not approved for vitamin B12 injection compensation, even though many parents have noticed extreme health benefits (cognition, energy, and mood) with routine B12 shots. So unless you’re diagnosed with pernicious anemia, , or dementia that’s not related to old age, you will have difficulty getting your insurance to pay for vitamin B12 supplements.
If your employer insurance plan covers naturopathic medicine, then you may be more successful. If you’re a senior citizen, then your risk for vitamin B12 deficiency is much higher. Still, Medicare Part D follows the same criteria for vitamin B12 shots as the Aetna plan. Unless you can present proof that you suffer from one of the approved medical conditions as mentioned above, you may not get coverage for vitamin B12, even if you are suffering from extreme fatigue, sluggish thinking, mood problems, or other ailments that can happen even if blood tests indicate normal levels of vitamin B12. If you’re turned down for Medicare or other healthcare compensation for vitamin B12 supplements, then fear not; there are other options. While vitamin B12 shots can be expensive, costing upwards of $25 a pop, there are alternative methods of vitamin B12 supplementation that are available online and over the counter (OTC). Many are cheaper, gentler, and more convenient than vitamin B12 shots, and just as likely to get absorbed into your bloodstream.