What Doctors need to know: Rules and regulations on billing for H1N1 vaccine.
Lets take a look at billing for H1N1 vaccine, something that you might have to do this year if you are running a medical practice.
The medicare coverage and reimbursement rules for the H1N1 vaccine are as follows:
As stated by the CMS, “Part B deductible and coinsurance do not apply for the seasonal influenza virus vaccine and its administration. the seasonal influenza vaccine is administered once a year in the fall or winter. Additional influenza vaccines are covered by Medicare when deemed to be a medical necessity. the Influenza A (H1N1) virus has been identified as an additional type of influenza. Medicare will pay for the administration of the H1N1 vaccine.
* G9141 – (H1N1) immunization administration (must include physician counseling the patient/family)
* G9142 – Influenza (H1N1) vaccine, any route of administration
Please note: The vaccine is provided to the doctors at no cost, you will not be able to bill for the vaccine.
Medicare will reimburse Medicare beneficiaries, up to the fee schedule amount, for the administration of H1N1 influenza vaccine when furnished by a provider not enrolled in Medicare.
Medicare will pay for seasonal flu vaccinations even if the vaccinations are rendered earlier in the year than normal.”
For additional information, please visit the CMS website.
Also, The American Medical Association (AMA) issued a clarification regarding the appropriate method of reporting codes for the H1N1 (swine flu) vaccine and administration. It is appropriate to report general pandemic vaccine code 90663 (Influenza virus vaccine, pandemic formulation) for the H1N1 vaccine, according to a notification that was sent out to AMA listserv subscribers on August 12.
Coders may report the appropriate immunization administration code (CPT codes 90465–90474) in conjunction with code 90663 for the administration of the vaccine, depending on the route of administration and the age of the patient.