Practice Management Alert

Question: Our practice is planning to offer H1N1 vaccinations. How should we bill for the vaccine and the administration?

New York Subscriber

Answer: Your billing will depend on the payer.Medicare will cover the administration of the H1N1 vaccine for Medicare Part B beneficiaries as an additional preventive immunization service. CMS created HCPCS code G9141 (Influenza A [H1N1] immunization administration [includes the physician counseling the patient/family]), effective for dates of service on and after Sept. 1, 2009.

According to MLN Matters article SE0920, payment will be similar to the administration of the seasonal influenza vaccine. Medicare will pay G9141 with V04.81 (Need for prophylactic vaccination and inoculation against certain viral diseases; other viral diseases; influenza) at the same rate established for G0008 (Administration of influenza virus vaccine).

Alternative: The AMA has also issued a new CPT code specific to H1N1 vaccine administration: 90470 (H1N1 immunization administration [intramuscular, intranasal], including counseling when performed). Some  private payers may accept G9141 while others use the specific CPT code or the appropriate CPT administration code based on the age of the patient and the method of administration (90465-+90474, Immunization Administration of Vaccines/Toxoids), so check with the individual payer to see which code it wants your practice to use.

Caution: One important thing to note, however, is that you should not bill at all for the vaccine, unless you submit a $0 amount.

How it works: The government is providing the H1N1 vaccine free to providers. That means your practice shouldn't get paid for it. Medicare doesn't want you to file a claim for the drug at all, even though G9142 (Influenza A [H1N1] vaccine, any route of administration) exists. The AMA says that you should report 90663 (Influenza  irus vaccine, pandemic formulation, H1N1) with 90470, but you should bill a zero-dollar charge.

-- The answers to the Reader Questions and You Be the Billing Expert were provided or reviewed by Barbara J.Cobuzzi, MBA, CPC, CENTC, CPC-H, CPC-P, CPC-I, CHCC, president of CRN Healthcare Solutions, a coding and reimbursement consulting firm in Tinton Falls, N.J., and senior coder and auditor for The Coding Network.