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Thread: E&M with Flu shot-Medicare

  1. #1
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    Default E&M with Flu shot-Medicare

    Silly question, but here goes. We are running a flu clinic, and we have special pricing for the flu season on the shots. If the Medicare patient has the shot with an E&M, I am not allowed to bill the G0008 at the same time as the E&M right? So, what do I tell my boss about that $$?
    Does this make sense?
    Thanks

    (I'm on medication, don't judge)

  2. #2
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    1 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.

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

    Page 12

  3. #3
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    Thanks

  4. #4
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    Quote Originally Posted by kjdallas View Post
    Silly question, but here goes. We are running a flu clinic, and we have special pricing for the flu season on the shots. If the Medicare patient has the shot with an E&M, I am not allowed to bill the G0008 at the same time as the E&M right? So, what do I tell my boss about that $$?
    Does this make sense?
    Thanks

    (I'm on medication, don't judge)
    NO- You can bill for the flu vaccine and admin w/the E & M....Just make sure you put modifier 25 on your E & M....,
    Yolanda T. Haskins CPC, CRC, CMCO
    AAPCCA Board of Directors 2014 - 2017
    Region 2 - Atlantic DE, MD, NJ, PA, DC


    Yolanda.Haskins@aapcca.org

    Alexandria, VA Chapter


    ~ Practice Kindness ~

  5. #5
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    If the purpose of the encounter is to receive the flu shot, then no there is no justification for an E&M, If there is a significant reason for the encounter and the decision is made to administer the flue shot incidental to the reason for the encounter then yes you may bill the E&M with a 25 modifier.

    Debra A. Mitchell, MSPH, CPC-H

  6. #6
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    Smile

    Quote Originally Posted by mitchellde View Post
    If the purpose of the encounter is to receive the flu shot, then no there is no justification for an E&M, If there is a significant reason for the encounter and the decision is made to administer the flue shot incidental to the reason for the encounter then yes you may bill the E&M with a 25 modifier.
    Correct......
    Yolanda T. Haskins CPC, CRC, CMCO
    AAPCCA Board of Directors 2014 - 2017
    Region 2 - Atlantic DE, MD, NJ, PA, DC


    Yolanda.Haskins@aapcca.org

    Alexandria, VA Chapter


    ~ Practice Kindness ~

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