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E/M & Vaccine on Separate Dates


Best answers
I have been told not to bill the flu vaccine and an E&M code on the same date of service. In the past, when a patient came in for the flu vaccination and was seen by the physician for other medical reasons, we billed an E&M code, attach mod 25, and billed the flu vaccine along with the proper administration code. I was told that we were billing incorrectly and that we should have the patient come in on a different day either to address the medical issue or to get the vaccine.

Any inputs will be greatly appreciated.


True Blue
North Carolina
Best answers
You have been misinformed. If there is supportive documentation, both are billable.

Billing for Additional Services

If a physician sees a beneficiary for the sole purpose of administering the influenza virus vaccine, the pneumococcal vaccine, and/or the hepatitis B vaccine, they may not routinely bill for an office visit. However, if the beneficiary actually receives other services constituting an “office visit” level of service, the physician may bill for a visit in addition to the vaccines and their administration, and Medicare will pay for the visit in addition to the vaccines and their administration if it is reasonable and medically necessary.


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