As the US population ages, more Americans are enrolling in Medicare. Today, over 67 million people, or roughly 20% of the population are covered. For pharmacies, this growth creates an Important opportunity to broaden services, increase revenue, and strengthen their role in patient care.
Here are four high-value Part B service areas pharmacies can explore. With the right setup, each can deliver significant clinical impact and financial return.
Covered Medications and Biologic Infusions
Dispensing Part B drugs and biologics especially those administered in-clinic, like injections or infusions is a natural extension of pharmacy operations. However, billing for these requires strict adherence to medical necessity documentation and Local Coverage Determinations (LCDs), which outline:
- Conditions deemed medically necessary
- Quantity limits
- Documentation requirements
Training staff to understand and document according to LCDs is critical for successful reimbursement.
Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS)
Pharmacies can also bill for DMEPOS items such as diabetic shoes, nebulizers, and ostomy supplies under Medicare Part B. This requires:
- Accreditation from a CMS-approved organization, unless exempt
- Submission of policies and procedures that align with accreditation standard
- An onsite survey
Pharmacies may be exempt from accreditation if they meet all the following criteria:
- Enrolled in Medicare for at least five years
- No adverse actions in the past five years
- Less than 5% of total pharmacy billing comes from DMEPOS
Immunizations Covered Under Part B
Vaccines such as influenza, pneumonia, COVID-19, and certain hepatitis B cases are reimbursable under Part B. Administering these vaccines is operationally straightforward, provided the pharmacy is authorized under state law and enrolled using CMS-855B or PECOS.
Point-of-Care Testing (POCT)
POCT is one of the fastest-growing services in pharmacies. CLIA-waived tests, including those for COVID-19 and influenza are eligible for Part B reimbursement.
- Obtain a CLIA Certificate of Waiver using CMS Form 116 and applicable state forms
- Complete Medicare enrollment using CMS-855B or PECOS
By completing these steps, pharmacies not only expand access to care but also unlock a sustainable billing opportunity aligned with growing patient demand.
Understanding Medicare Part B Enrollment
To bill for any of these services, pharmacies must first enroll as Part B providers or. Key steps include:
- Selecting the correct form: CMS-855B (for clinical services such as immunizations or POCT) and/or CMS 855S (for Part B medications and DMEPOS)
- Completing the application with NPI, legal business details, accreditation (if required), and bank information
- Submitting via PECOS or a paper application, paying any required fees, and responding promptly to follow-ups
Receiving a PTAN (Provider Transaction Access Number), typically within 90 days.
Why These Services Matter for Your Pharmacy
Expanding into these Part B-covered service areas allows pharmacies to:
- Diversify revenue beyond traditional dispensing
- Strengthen patient engagement through expanded clinical services
- Position themselves as trusted care hubs in their communities
- Create new reimbursement streams that support profitability
Understanding compliance, accreditation, and billing requirements, especially around LCDs, CLIA waivers, and Medicare enrollment, is essential for successful implementation.
How HealthRecon Connect Can Help
At HealthRecon Connect, we provide pharmacy-tailored revenue cycle management (RCM) support to help you onboard and bill these Part B services with confidence.
Our services include:
- Enrollment guidance (CMS-855B/855S, PECOS submissions, fee management)
- LCD and coverage requirement training
- POCT setup assistance (CLIA waiver, test coding)
- DMEPOS accreditation preparation
- Optimizing Immunization Claims and Payment Workflows
We equip your team with the tools and expertise needed to expand services, improve reimbursements, maintain compliance, so you can focus on patient care and growth.
Ready to Expand Your Medicare Part B Services?
Let’s connect and explore how your pharmacy can take advantage of these growing opportunities with streamlined billing, training, and operational support from HealthRecon Connect.
Contact us: sales@healthreconconnect.com
Learn more: www.healthreconconnect.com