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Thread: Billing pneumonia vac in nh setting

  1. #1

    Default Billing pneumonia vac in nh setting

    AAPC: Back to School
    Does anyone know if a doctor can administer a pneumonia vaccine in a nursing home and bill Medicare? (We have had problems with flu vaccines in the past and Medicare had recouped their payment).

  2. #2
    Join Date
    Apr 2007


    Look into using the GV and GW modifiers. Don't have my book in front of me but one states the doc is not billing under the nursing home and the other states it is unrelated to the nursing home stay. That should work.
    Kimberly Jawidzik, CPC
    MedAssure, LLC
    Physician Billing & Consulting

  3. #3
    Join Date
    Apr 2007
    Naples Florida


    They may be paid by the facility but may not be paid by Part B, I think does not cover as it is included with consolidated billing as I know flu is paid by the provider directly by the nursing home.

    Check out Medicares information on consolidated billing for facilities and this should give you some information or check the facility if you have a contact or on good relationship with them.

    I hope this helps somewhat.

  4. #4


    The GV modifier pertains to hospice and whether or not the attending physician is employed by or paid under agreement by the patient's hospice provider. The GW modifier states that the service provided is not related to the hospice patient's terminal condition. Just because the patient is in a nursing home, does not necessarily mean that they are receiving hospice care, so these modifiers would not be appropriate.

    When an attending (not employed by the nursing home) provides a service to a nursing home patient (be it in the office or in the nursing home), the provider has to bill the nursing home as the nursing home has already been paid by CMS.

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