Part B Insider (Multispecialty) Coding Alert

Published on Fri Aug 07, 2009 PDF

Plus: New Bevacizumab code is effective Oct. 1.

If you're planning to administer the vaccination for H1N1-- also known as the "swine flu" (488.1) -- the odds of collecting for the vaccine administration just improved. On Aug. 28, CMS released MLN Matters article MM6617, which introduces two new codes that apply to the H1N1 vaccine, as follows:

• G9142 -- Influenza A (H1N1) vaccine, any route of administration is the code for the vaccine itself;

• G9141 -- Influenza A (H1N1) immunization administration (includes the physician counseling the patient/family) refers to the vaccine administration.

Remember: Because the H1N1 vaccine is available to providers free of charge, you should not bill Medicare for the vaccine itself -- only for the administration, said CMS's Stewart Streimer during an Aug. 25 CMS Open Door Forum.

"Providers should report one unit of HCPCS code G9141 for each administration of the H1N1 vaccine," the MLN Matters article notes.

Payment: CMS intends to pay you the same amount for G9141as it  reimburses for G0008 and G0009."The reimbursement varies by state, but ranges from about $18.00 to $25.00," says Atlanta-based coding consultant Jay Neal. You can find your state's rate at www.cms.hhs.gov/AdultImmunizations/Downloads/AdminRates09.pdf, Neal says.

Bonus: Although Medicare normally pays for just one vaccination per year, it will pay for both a seasonal flu vaccine and an H1N1 vaccine if both are medically necessary, according to a Sept. 2 email from CMS to all fee-for-service providers.

Plus: CMS released an additional HCPCS code last week for Bevacizumab, a cancer drug. The new code will be effective as of Oct. 1:

• Q2024 -- Injection, Bevacizumab, 0.25 mg Currently, CMS has assigned Q2024 a procedure status of E, which means the code is excluded from the Physician Fee Schedule by regulation. However, MACs may pay it under "reasonable charge procedures."

To read the MLN Matters article regarding the H1N1 vaccination, visit www.cms.hhs.gov/MLNMattersArticles/downloads/MM6617.pdf. To read more about the new Bevacizumab injection code, visit www.cms.hhs.gov/MLNMattersArticles/downloads/MM6594.pdf.