Author Topic: coding and fees for H1N1 vaccine  (Read 1551 times)


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coding and fees for H1N1 vaccine
« on: September 22, 2009, 03:39:49 PM »
In preparation for the swine flu vaccine ... please tell me what to use at the cpt code and if there is an ICD-9 code available yet. 


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Re: coding and fees for H1N1 vaccine
« Reply #1 on: September 23, 2009, 06:18:40 AM »

The Centers for Medicare & Medicaid Services (CMS) has created two new HCPCS codes for H1N1, effective for dates of service on and after September 1, 2009:

G9141—Influenza A (H1N1) immunization administration (includes the physician counseling the patient/family)

G9142---Influenza A (H1N1) vaccine, any route of administration
Payment for G9141 (Influenza A (H1N1) immunization administration, will be paid at the same rate established for G0008 (Administration of influenza virus vaccine). H1N1 administration claims will be processed using the diagnosis V04.81 (influenza), and, depending on the provider type, using revenue code 771. The same billing rules apply to the H1N1 virus vaccine as the seasonal influenza virus vaccine with one exception. Since the H1N1 vaccine will be made available at no cost to providers, Medicare will not pay providers for the vaccine. Providers do not need to place the G9142 (HIN1 vaccine code) on the claim. However, if the G9142 appears on the claim, only the claim line will be denied.
Payment will not be made to providers for office visits when the only purpose of the visit is to administer either the seasonal and/or the H1N1 vaccine(s).
Providers who normally participate in the Medicare Part B program as mass immunizer roster billers and mass immunizer centralized billers may submit H1N1 administration claims using the roster billing format. The same information must be captured for the H1N1 roster claims as it is for the seasonal influenza roster claims.

For commercial and private payors you have to call them, some of the carriers want you to report the vaccine using a $0.01 charge for electronic claims, some carriers don't want the claim line with the vaccine since none of them will pay for it they will only pay for the administration (govt is providing the vaccine free to providers)  You also cannot bill an office visit for the purpose of administering the vaccine only .  Here's the information I've gathered on some of the payors in regards to the H1N1 Vaccine:

Cigna wants G9141

Aetna  90465-90468 For children and 90471-90474 for adults. They will also accept G9141

Humana - wants G9141

BCBS - will vary, you have to call your local BCBS plan

Well Point and Anthem have not released instructions

United Healthcare: CPT vaccine administration code appropriate to patient age,(90465-90468  90471-90474)   route of administration and number of vaccines administered. In addition, physicians must submit CPT code 90663 for the vaccine itself and indicate an amount of $0.01. The federal government is providing the vaccine free of charge, but some claims clearinghouse systems will reject CPT codes with a $0 charge.

Cigna -
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers


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Re: coding and fees for H1N1 vaccine
« Reply #2 on: September 23, 2009, 09:59:25 AM »
your reply needs to be sticky noted. I don't bill for this (currently), but its very detailed and a great reference.
Thanks Linda