Here's How to Get Paid for Administering H1N1 Vaccine

Major Payers Issue Coding Instructions

By News Staff
Posted: 9/16/2009, 4:55 p.m.

The FDA's approval of four vaccines against the novel influenza A (H1N1) virus is official. Now, physicians in private practice need details from health insurance companies about how to code and bill payers for administering the vaccine to receive timely payment for this service.

CMS has created a unique health care common procedure coding system, or HCPCS, code -- G9141 -- specifically to cover administration of the H1N1 vaccine, although private insurers are not required to use the G code.

The AAFP has confirmed the following instructions from the country's largest private health insurers and Medicare.

UnitedHealthcare is asking physicians to submit the CPT vaccine administration code appropriate to patient age, route of administration and number of vaccines administered. In addition, physicians must submit CPT code 90663 for the vaccine itself and indicate an amount of $0.01. The federal government is providing the vaccine free of charge, but some claims clearinghouse systems will reject CPT codes with a $0 charge.
CIGNA is asking physicians to bill for the administration of H1N1 flu vaccines using the new G9141 HCPCS code.
Aetna wants physicians to use age-appropriate CPT codes -- 90465-90468 for children or 90471-90474 for adults. Use of the G9141 HCPCS code also is permissible.
Humana prefers that physicians use the HCPCS G9141 code when filing a claim for administration of the H1N1 vaccine.
Because of the large number of Blue Cross Blue Shield companies, the AAFP cannot give definitive instructions for these payers. If physicians have questions about H1N1 vaccine administration payment, they should contact their local BCBS plan.
WellPoint and Wellpoint's subsidiary, Anthem, have not released instructions to physicians regarding administration of the H1N1 vaccine.
Medicare wants physicians to bill for administration of the H1N1 vaccine using the HCPCS G9141 code. Payment will be the same as for administration of the seasonal influenza vaccine. More information about CMS' H1N1 vaccine payments is available in a recent MLN Matters.