CMS Creates G Code to Ensure Physician Payment

Family physicians with Medicare patients who should be immunized against herpes zoster, commonly known as shingles, need to know how to code for administration of the vaccine -- Zostavax -- in order to be paid for their service.

CMS has created a new "G" code -- G0377 -- specifically for the administration of Medicare Part D vaccines such as Zostavax. The code went into effect Jan. 1 and remains active for one year. It stipulates that payment for G0377 will be the same as for CPT code 90471, or $19.33 (national average).

Cynthia Hughes, AAFP's coding and compliance specialist, said she has been fielding calls from members who are confused about how to bill for the administration of Zostavax.

Information on the new G code is spelled out in a recent issue of Medlearn Matters, (PDF file: 5 pages / 102 KB. More about PDFs.) CMS' online publication for health care providers, as well as in the coding area of AAFP's Web site.

Hughes noted that Zostavax was created to reduce the risk of shingles in older patients and that Medicare Part D plans often cover the cost of the vaccine. "With patient demand for the vaccine on the rise, it's important that family physicians have the correct coding information on hand for billing purposes," said Hughes.

According to Medlearn Matters, the G code has been created for the administration of all vaccines that are covered under Medicare Part D. Physicians should bill their local carrier for administration of the vaccine; normal beneficiary deductible and coinsurance requirements apply.

Physicians take note: Payment for Medicare Part D-covered vaccines is made solely by the participating prescription drug plan. Medicare Part B will not pay for the vaccine itself.