Health Information Management

Q/A: Billing for H1N1 flu vaccine administration

APCs Insider, January 15, 2010

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Q: We submitted claims to Medicare for the H1N1 flu vaccine using CPT code 90470 (H1N1 immunization administration [intramuscular, intranasal], including counseling when performed). However, Medicare didn’t pay for the administration of the vaccine. Why not and what must we do to receive payment?
 
A: For Medicare, hospitals must report HCPCS code G9141, Influenza A (H1N1) immunization administration (includes the physician counseling the patient/family) to bill for the administration of the vaccine, using diagnosis code V04.81 (influenza). Institutional providers, depending on provider type, also should use revenue code 771.Billers may, at their discretion, include a claim line for the H1N1 vaccine itself by reporting HCPCS code G9142 (Influenza A (H1N1) vaccine, any route of administration), but providers who receive the vaccine at no cost will not receive payment.



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