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Billing admininstration for flu and pneumonia vaccines with E/M service

  1. Default Billing admininstration for flu and pneumonia vaccines with E/M service
    Medical Coding Books
    In studying the practicum for E/M certification, information was presented in the first lecture stating that G0008 and G0009 (administration of flu and pneumonia vaccines respectively) could only be billed if there was no other physician fee schedule service on the same day. In other words, if the patient presented only for the immunizations, the adminstration codes could be billed; but when administered in conjunction with an E/M service, the administration fee was bundled into the E/M and not separately billable.

    In reviewing the Medicare manual, I could find no supporting documentation. Did I misunderstand what the presenter was saying, or is there verifiable information supporting this information?

    Thank you so much for your help!

  2. #2
    North Carolina
    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.


  3. Default Flu and Pneumo administration
    Thanks Rebecca! I had also found that information in the CMS manual; but was thrown by the instructor's lecture which stressed that the administration wasn't to be billed when an E/M service was performed. I appreciate your help! Kathy

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