Health Information Management

Healthcare news: H1N1 codes take effect despite being omitted from CPT Manual

JustCoding News: Outpatient, October 21, 2009

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Although CPT codes 90470 and 90663 are not in the CPT® 2010 Professional Edition, providers may report these H1N1 (swine flu) codes effective immediately.

According to guidance on the American Medical Association (AMA) Web site:

To seek payment from payers following administration of 2009 H1N1 influenza type A monovalent vaccine, providers should bill CPT code 90663 (Influenza virus vaccine, pandemic formulation, H1N1) in conjunction with the immunization administration code 90470 (H1N1 immunization administration (intramuscular, intranasal), including counseling when performed). The 90663 code for the 2009 H1N1 vaccine itself should be billed for zero dollars, since the vaccine is provided free of charge by the federal government. Providers will be paid for 2009 H1N1 vaccine administration.

Access an AMA fact sheet on reporting for H1N1. Access a related CMS fact sheet.

In other news related to the actual vaccine, CMS added one new HCPCS code, effective October 1—Q2024 (injection, Bevacizumab 0.25 mg) to APC 1281. Q2024 has status indicator K, meaning CMS will pay for it separately.

CMS also added two new HCPCS codes that are effective October 1:

  • G9141: Influenza A (H1N1) immunization administration (includes the physician counseling the patient/family)
  • G9142: Influenza A (H1N1) vaccine, any route of administration

Hospitals will be paid for G9141 under APC 350, for which the July reimbursement rate was $24.89. No deductible applies to G9141. Hospitals will not receive separate reimbursement for G9142 because CMS believes hospitals will not have to pay for the vaccine.

Access MedLearn Matters article MM6617 to learn more about reporting for H1N1.

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