H1N1 Vaccine Reporting Codes in CPT®

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  • October 5, 2009
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The American Medical Association (AMA) has created a new CPT® code specific to vaccine administration and revised an existing code to include the H1N1 vaccine.

“The new CPT® code will streamline the reporting and reimbursement procedure for physicians and health care providers who are expected to administer nearly 200 million doses of the H1N1 vaccine in the United States,” the AMA states in an Oct. 2 eVoice report. “The codes also will help efficiently report and track immunization and counseling services related to the H1N1 vaccine throughout the health care system.”

Use newly created code 90470 H1N1 immunization administration (intramuscular, intranasal), including counseling when performed to report H1N1 immunization administration and counseling. Use revised code 90663 Influenza virus vaccine, pandemic formulation, H1N1 to report the H1N1 vaccine product.

Both revised codes 90663 (still pending FDA approval) and 90470 are effective immediately.

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No Responses to “H1N1 Vaccine Reporting Codes in CPT®”

  1. Mary Klaus says:

    Are these codes for all Insurances, including Medicare? Their publication all say that the code to use for the administration is G9141 and G9142. We are not sure what to bill. Thanks
    Mary Klaus

  2. Annie Shoffit says:

    You would use the G9141 for just Medicare, and possible BC/BS, depending on you carriers requirement. When doing a flu swab, you do not have to use a screening code. You can use symptoms, such as fever, cough, sore throat, body aches, headache…

  3. Renelle says:

    I would check with each individual carrier. In my area (NY downstate), there are many commercial carriers that will accept both G9141 & 90470 for the admnistration.

  4. Judy Habetler says:

    I was just informed by one of my physicians that the correct coding schema for billing H1N1
    administration code 90470 with an administration of another vaccine on the same day would
    be to bill the additional code for the administered vaccine (ie mmr) and code 90472 as the 90470
    takes the place of 90471 in this scenario. Does anyone have clarification of this?? Thanks Judy Habetler

  5. Ashley C says:

    My recommendation is to poll each of your payers. So far (here in FL) we are being instructed by most of our carriers, including commercial, to use G9141 versus 90470.

  6. Marjorie Giardina says:

    Do we use the v04.81 code with the G9142 code when reporting administration of H1N1 vaccines. If not, which dx code is appropriate to use with the H1N1 vaccine?

  7. Tracy says:

    What about pricing on this code. Does anyone know if the reimbursement is going to be in the same range as the influenza immunization/vaccine?

  8. SUSAN MARINO says:

    Some of the carriers require 90663 for the H1N1 vaccine billed at .01 with the administration code. Physicians desk reference identifies this as intramuscular. Is it also used for H1N1 Flu mist?

  9. KIM CULP says:

    Does anyone have an idea of the average rate payors are going to reimburse for the admin of the H1N1 vac, or if the coinsurance and deductibles will apply?

  10. Marita says:

    To Kim Culp:Mcare will pay G9141 at same rate as current G0008 without applying ded and coinsurance. Don’t know what other payers will do.

  11. Pam says:

    Does anyone know, when billing H1N1 90663 & 90470 on the same day as another vaccine, i.e seasonal flu 90658, do we use 90471 or 90472 for the second admin code? I’ve gotten feedback both ways from payors.