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Thread: flu shot vs. office visit

  1. #1

    Default flu shot vs. office visit

    If a doctor bills an E/M visit with a flu shot, can you bill for the administration injection? Or is the admin. part of the E/M visit?
    Help.

  2. #2
    Join Date
    Apr 2007
    Location
    North Carolina
    Posts
    3,128

    Default

    More than likely, this will vary from carrier to carrier but for the purpose of MCR...

    "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"

    http://www.cms.gov/manuals/downloads/clm104c18.pdf

    Page 12

  3. #3

    Default

    Thank you. That was very helpful.

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