The codes created for this are as follows:
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.
Things to remember
• You cannot bill for the vaccine if you are receiving it free of charge from the state -- but remember you can bill for the administration. Just about everyone administering the vaccine should be receiving it free of charge from your state or city health department. Now with this said, you must know how your state requires you to submit the charge
-- you may have to add the vaccine injectible along with the adminstration code in order for you to get paid for the administration.* Sadly all payers are different.* Just make sure that if your system requires you to add the injectible to the claim to either zero out the charge or only charge a penny to ensure nonpayment for the vaccine (yes some payer's software does not catch it).
• The amount you will be reimbursed is state and payer specific, but generally ranges between $10 and $20.
• When billing Medicare: CMS has created two codes for administering the H1N1 vaccine - G9141-Influenza A (H1N1) immunization administration (includes the physician counseling the patient/family)* and G9142---Influenza A (H1N1) vaccine, any route of administration.
• Use the diagnosis code V04.81
• For private insurance carriers: the CPT code for H1N1 is 90663 and the administration code is 90470
• To seek payment from payers following administration of 2009 H1N1 influenza type A monovalent vaccine, providers should bill CPT code 90663 (Influenza virus vaccine, pandemic formulation, H1N1) in conjunction with the immunization administration code 90470 (H1N1 immunization administration (intramuscular, intranasal), including counseling when performed).
• Again, you would use diagnosis code V04.81
This is an excerpt from my presentation on the H1N1
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