Initial H1N1 Vaccine Not for Everyone
About 600,000 doses of H1N1 vaccine were delivered Oct. 6 to the 25 states that placed initial orders, according to an Oct. 1 Centers for Disease Control and Prevention (CDC) press conference, but two of the at-risk groups who need the vaccine most won’t be able to receive it.
“It’s a good vaccine, but it’s one that can’t be used in absolutely everyone,” said Rear Admiral Anne Schuchat, M.D., director, National Center for Immunization and Respiratory Diseases, during the H1N1 video briefing.
The initial shipment is live and administered by nasal spray, which isn’t suitable for individuals with chronic underlying conditions or pregnant women — the priority group the CDC says is at greatest risk. The initial 600,000 doses will instead be directed toward health care workers.
Schuchat also noted that 300,000 courses of liquid pediatric Tamiflu — an antiviral medication that can reduce the severity of flu symptoms — were released to states Oct. 1. Texas and Colorado should have received their courses Oct. 2.
“Some of the liquid formulations of Tamiflu will have an expiration date that may have passed, but we want people to know that the FDA has extended the expiration date of those courses after careful testing,” Schuchat said.
Coding for Antiviral Medicine
Because pregnant women are at higher risk for severe complications and death from influenza and seasonal influenza, recommended treatment includes G9019 Oseltamivir phosphate, oral, per 75 mg (Tamiflu®) twice per day for five days or 5 mg of G9018 Zanamivir, inhalation powder, administered through inhaler, per 10 mg (Relenza®) two times a day for a total of 10 mg per day for five days. Treatment should not wait for laboratory confirmation of a rapid influenza diagnostic test (87804 Infectious agent antigen detection by immunoassay with direct optical observation; Influenza.
Coding for the H1N1 Vaccine
Clinicians should use revised CPT® code 90663 Influenza virus vaccine, pandemic formulation, H1N1 to report the H1N1 vaccine product, and newly created code 90470 H1N1 immunization administration (intramuscular, intranasal), including counseling when performed to report H1N1 immunization administration and counseling.
For Medicare, report G9142 Influenza A (H1N1) vaccine, any route of administration to describe the H1N1 vaccine itself and one unit of G9141 Influenza A (H1N1) immunization administration (includes the physician counseling the patient/family) to describe each administration of the H1N1 vaccine. Beneficiary copayment and deductible do not apply to HCPCS code G9141.
Note that physicians cannot be reimbursed for the vaccine because it is free. Reporting G9142 is optional and edits are set up to deny the line item should it appear on a claim.
Under the Medicare Physician Fee Schedule (MPFS), HCPCS Level II codes G9141 and G9142 are 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.
Additional doses of the H1N1 vaccine will be distributed to states based on population. States determine where it goes from there. Provider requests go to the state health departments. The state health department immunization coordinator each day will know the allocation of vaccine available to that state. The state will determine where the vaccine goes and orders will be transmitted daily to the CDC, where they’ll be collated. The orders will then be transmitted to the distributor and those orders will be filled within three business days and shipped overnight express to provider Monday through Thursday, but not Friday or Saturday “because we don’t want vaccines showing up at locked doors or not being controlled or available,” said Jay Butler, M.D., medical epidemiologist and chief of the 2009 H1N1 vaccine task force in a Sept. 18 CDC briefing.
For a weekly update to this information, visit the H1N1 Video Briefing Archive on Flu.gov.