# E&M with Flu shot-Medicare



## kjdallas (Oct 1, 2010)

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)


----------



## RebeccaWoodward* (Oct 1, 2010)

*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


----------



## kjdallas (Oct 1, 2010)

Thanks


----------



## LOVE2CODE (Oct 2, 2010)

kjdallas said:


> 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....,


----------



## mitchellde (Oct 2, 2010)

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.


----------



## LOVE2CODE (Oct 2, 2010)

mitchellde said:


> 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......


----------

