Practice Management Alert

Question: Our practice is preparing to administer the H1N1 vaccine. How will we bill Medicare for this service? Will the carrier pay us?

Florida Subscriber

Answer: CMS just introduced two new G codes that will help you seek payment for the administering the H1N1, or "swine flu" vaccine. You'll use G9142 (Influenza A [H1N1] vaccine, any route of administration) for the vaccine and G9141 (Influenza A [H1N1] immunization administration [includes the physician counseling the patient/family]) for the administration.

Caveat: Even though you have a code you can bill for the vaccine, you shouldn't put it on your claim. Because the H1N1 vaccine is available to providers free of charge, you shouldn't bill Medicare for it.

CMS plans to pay you the same amount for G9141as it would pay you for flu shot and pneumonia vaccine administration codes G0008 (Administration of influenza virus vaccine) and G0009 (Administration of pneumococcal vaccine). While the actual reimbursement varies by state, you can find your state's rate at www.cms.hhs.gov/AdultImmunizations/Downloads/AdminRates09.pdf.

Bonus: Although Medicare normally pays for just one vaccination per year, it will pay for both a seasonal flu vaccine and an H1N1 vaccine if your physician documents that both are medically necessary.