H1N1 Vaccine HCPCS Codes Released

Two new Level II HCPCS codes were added to the 2009 Medicare Physician Fee Schedule Database (MPFSDB) in the October update. Effective Sept. 1, report code G9142 Influenza A (H1N1) vaccine, any route of administration to describe the H1N1 vaccine itself, and G9141 Influenza A (H1N1) immunization administration (includes the physician counseling the patient/family to describe the administration of the H1N1 vaccine.

Providers should report one unit of G9141 for each administration of the H1N1 vaccine.

Under the MPFS, G9141 and G9142 have been assigned status indicator “X,” indicating these codes represent an item or service that is not within the statutory definition of “physicians’ services” for MPFS payment purposes.

The H1N1 vaccine will be supplied at no cost to providers. Payment for G9141 will be the same as that for G0008 Administration of influenza virus vaccine and G0009 Administration of pneumococcal vaccine, which is currently based on CPT® code 90471 Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); one vaccine (single or combination vaccine/toxoid). Beneficiary copayment and deductible do not apply.

Approximately 50 million doses of H1N1 vaccine are expected to be available by mid-October, according to the Centers for Disease Control and Prevention (CDC).

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42 Responses to “H1N1 Vaccine HCPCS Codes Released”

  1. Confused says:

    I just sent an e-mail out today at work to the fact that we did not have confirmed codes as of yet. I did see a document that the AMA has sent that stated that the H1N1 vaccine CPT code was the pandemic flu code of 90663, i think. But according to this are we supposed to use the regular flu vaccine code? I am so confused. Is the ICD-9 code the same?

  2. Vanessa says:

    The diagnosis code for H1N1 will be 488.1. This code will be effective beginning October 1, 2009.

  3. Jess Coleman says:

    Will the v code be v04.81? That’s what we currently use when a flu shot is administered.

  4. Debbi says:

    In this article it tells what Medicare CPT codes are but what are we using for non-Medicare patients and are we using 90471 for the admin fee?

  5. Stephanie says:

    According to CMS MLN Matters #SE0920, the correct DX code for the H1N1 vaccine is V04.81,
    and providers will not be paid for the vaccine, since the vaccine will be made available at not cost
    to providers; so you would only bill G9141 for the administration

  6. Jamie jolley says:

    If we are only “screening” for influenza, what dx code would we use to send to the lab? V73.89 seems to be the closest one I am able to find. Any other suggestions or answers?

  7. Confused 2 says:

    I’m seeing documentation from Medicare stating to use G9141 for the admin and G9142 for the vaccine. I saw another article stating the opposite. Will all other commercial payors be using 90663 for the H1N1 vaccine code? Should we be using V04.81 as the dx as wellas the patient is getting the vaccine as a preventive not becuase they have the swine flu. If a patient present with the swine flu we would use 488.1 for the dx.

  8. Deb Kober says:

    Will the code be 90663 or 90471 for commercial providers? Thanks

  9. Empteenest says:

    We have been instructed by our Manager to use 90471 for anything other than Medicare.

  10. Karyl Baiey says:

    One of the CMS articles listed G9141 administration with counseling and G9142 administration any route using Dx of V04.81. But another stated G9142 was the vaccine code which does not make sense. It will be provided free to providers anyway so you dont need the vaccine code. I would like to know what Medicare is paying for the G0008 and 90658 as I have not been able to find it in their fee schedule. The G9141, CMS states is paid the same as the G0008.

  11. Monica says:

    You WILL need the vaccine code, even if you are using a zero charge. You have to show which flu vac you are administering…

  12. Carrie says:

    The CDC is supplying the vaccine free of charge, so you (as physician practices) will only be charging for the administration of the vaccine. You may enter a code (G9142 or 90663), however if you do use it (for documenting in your A/R what was adminisered), you would assign a zero ($0.00) amount to the vaccine codes. We have found that some of our private payers are requesting the G9141 administration code rather than 90471-90472 codes. You may want to check your major payers to see what they want submitted.

  13. Barbara says:

    Our local payors are instructing us to bill the G9141 for the administration of the H1N1 vaccine. They further state that G9142 is not required on the claim to be paid (since the vaccine is free).

  14. Susie says:

    If we administer the H1N1 Vaccine and the Seasonal Influenza Vaccine at the same which G code would we use for the intial administration? G0008 or G9141?

  15. Debbi says:

    I have primary care providers asking if we can charge for a mini mental status exam but can’t seem to find any code but 96116. Does anyone charge for these?

  16. Linda says:

    Please also remember DMAS – Medicaid applies reimbursment of the Administration on the Vaccine.

  17. Kathleen says:

    There is alot of information out regarding coding. Someone mentioned using 90471 as the administering of H1N1. Information I received from one publication (UHC being one) was that 90470 was being created for H1N1, for any route. My biggest worry right now is that claims get denied because we have made a wrong choice in which code to apply for the administration, which is chargable. UHC now says they want $0.01 put in for a price on the unchargable vaccine, due to the fact that their system isn’t updated to accept claims billed at $0.00. So I suspect that we will bill all at a penny and hope there are no denials for charging $$$ for something that is suppose to be free.

  18. KAVITHA says:

    do i bill V04.81 with a G9141 to get paid for admin of h1n1 any route and do i charge like i do for a g0008

  19. susan says:

    H1N1 administration is 90470
    vaccine 90663
    dx v04.81

    This is how I understand it for non-medicare billing.

  20. lynn says:

    medicaid states 90470 is a rest home code- not covered
    what is the correct billing codes for H1N1 for medicaid

  21. Jacquelyn says:

    I got two different sets of codes; DX is V04.81, same as old flu-vac code

    AMA says H1N1 Immunization IM, including counseling when provided 90470
    Influenza virus vaccine, (H1N1) pandemic formulation 90663

    CMA (Medicare) says Influenza A (H1N1) vaccine, any route of administration G9142
    Influenza A (H1N1) immunization with physician counseling G9141
    Administration is the old code for Flu admn. G0008

  22. AMIN SHAIKH says:

    As per my knowledge correct CPT codes for H1N1 ARE
    90470 $30.00
    90663 $00.00

    YOU CAN USE ICD 488.1

  23. Brandi Gibson says:

    Recevied Fax blast from Medicaid released 10/16/09 that states:

    to submit vaccine administation procedure code 90465,90466,90471 or 90472, providers must include on claim the H1N1 pandemic flu vaccine procedure code 90633, which will process as informational only
    to submit vaccine administration procedure code 90470, which is specific the administration of the H1N1 vaccine, providers DO NOT need to include hte procedure code 90633

    The is from TMHP you can also find this same info on http://www.tmhp.com- flu information-Update for H1N1 vaccine adminstration claim submission

  24. Christine Healey says:

    Is there a separate code for preservative free H1N1 vaccine ?

  25. KIMBERLY WILLIAMS says:

    Do we still need to use the 90465 code for administration under 8years of age. I have not seen any one mention this yet?

  26. Leviah Hauer says:

    As per the guidelines for seasonal flu vaccination, are there separate codes for H1N1 mist, H1N1 shots for patients above 3 years of age , and H1N1 shots for patients under 3 years of age?

  27. Carolyn says:

    I am total confused do we use ICD diagnosis V04.81 and CPT code 90470 for adminstation of vaccine and counseling please help and how much can we charge

  28. tina says:

    we gave a H1N1 and other vaccines to the patient on same day. We used the proper H1N1 code 90470 and the 90633 and used 90471 with the other vaccine. Our carriers says we should have used a 90472 instead……?

  29. Sharon says:

    What revenue code are you using for the 90470, 90633 and 90471 with the
    H1N1 vaccination?

  30. Sharon says:

    What revenue codes do you use for 90470, 90663, and 90471?

  31. renee says:

    Please see this MLN Matters article for any questions pertaining to H1N1 coding.

    http://www.cms.hhs.gov/MLNMattersArticles/downloads/se0920.pdf

  32. Amy says:

    I am not able to find any official notification these codes will ever be reimbursed G9142. Have I missed it somewherre?

  33. MCONTRERAS says:

    I need your help..what place of service would be used for administration of the H1N1 vaccine at a school setting

  34. Molly says:

    Revenue code: 0771
    HCPC code: G9141
    DX: V04.81

    I did not use the vaccine code to get this reimburse. I only used the administering code and was able to get reimburse. Medicare reimburses 20.72 for 2010.

    This is for Medicare- and I work in a SNF, but these charges are our outpatient residents.

  35. angela says:

    i have notice that when we submit G9142 with the administration 90473 medicaid insurances has either denied this claim or has made it incidental to administration 90471. why?

  36. Barb says:

    I understand that there is a new code that needs to be used for the flu shote for 65 years of age and older. Is this correct and does anyone know what that code will be? Also, and idea when it becomes effective?

  37. Melissa says:

    Fluzone High-Dose vaccine is indicated for people 65 years of age and older and will be available for administration during the upcoming 2010-2011 influenza season. Fluzone High-Dose vaccine has received a unique CPT®a Code 90662.

    The FDA approval pending indicator (

  38. Melissa says:

    The FDA approval pending indicator (

  39. Melissa says:

    The FDA approval pending indicator was removed from code 90662 following notification that this product achieved FDA approval status on December 23, 2009.

  40. Sue Lebbin says:

    What would be the administration code that we would use for Medicare with the 90662 for the high dose flu vaccine?

  41. Tamara says:

    Does anyone know yet what Admin code we use for 90662 for mcare yet?

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