Medicare Updates Hep B Admin Code Guidance

Effective for claims processed with dates of service on or after Jan. 1, 2011, Outpatient Prospective Payment System (OPPS) providers should report HCPCS Level II code G0010 Administration of hepatitis b vaccine for the administration of hepatitis b vaccine, rather than CPT® 90471 Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid) or 90472 Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure).

This policy has been in effect since Jan. 1, 2011, but the Medicare Claims Processing Manual was not updated at chapter 18, section 10.2.1 to reflect the correct billing instructions.

Claims processed incorrectly prior to July 2, 2012 should be brought to the attention of your contractor on or after July 2, 2012 for adjustment.

Source: MLN Matters® MM7692, issued Jan. 25, 2012.

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2 Responses to “Medicare Updates Hep B Admin Code Guidance”

  1. Gina says:

    We are a pediatrics office and do not bill medicare claims so therefore do we have to use the HCPCS G0010 code for administration of Hep B?

  2. Anne says:

    G0010 is for Medicare beneficiaries only. For all other payers use 90471/90472.

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