AAFP Web Resource Transmits Latest Payer Instructions for Administering H1N1 Vaccine

Nailing down the correct coding information for administration of the vaccine for novel influenza A (H1N1) virus is proving to be nearly as daunting a task as distribution of the vaccine itself. So, to keep family physicians abreast of the most current coding instructions from the nation's largest payers, the AAFP has created a page on the Academy's Web site devoted to H1N1 administration coding.

Payer information will be updated as quickly as it can be verified by the Academy and will be denoted as "new" and labeled by posting date, according to Cynthia Hughes, C.P.C., AAFP's coding and compliance specialist.

The FDA's recent approval of four vaccines against H1N1 led CMS to create a unique health care common procedure coding system, or HCPCS, code -- G9141 -- specifically to cover administration of the H1N1 vaccine. In addition, the AMA's Current Procedural Terminology Editor Panel has approved a new code -- CPT code 90470 -- to report H1N1 immunization administration, both intramuscular and intranasal, including counseling when performed. The editorial panel also revised code 90663 to specifically refer to the H1N1 vaccine rather than a generic pandemic influenza virus.

Both codes were effective as of Sept. 25.

However, creation of the new vaccine administration codes doesn't mean payers will require vaccine providers to use the code. At the time this news story posted, the Academy had verified the following information from public and private payers:

Physicians will be paid the same amount regardless of which code is used.

In addition, the above payers say it is not necessary to report a code for the vaccine itself because the federal government is providing the vaccine free of charge. However, if providers choose to include CPT code 90663 for the vaccine product, they should include an amount of $0.01 because some clearinghouse systems will reject claim lines with a $0 charge.

Use of the correct billing codes will help ensure that vaccine administrators, many of whom may be family physician practices, receive prompt and accurate payment for their services. The AMA estimates that U.S. health care professionals will administer as many as 195 million doses of the H1N1 vaccine.

Hughes is urging physicians to act quickly to add the new codes into their billing systems so they will be prepared to bill for administering the vaccine as soon as it becomes available. "It's possible that some practices may need help from their IT (information technology) vendors to get the codes uploaded. AAFP members would be wise to make those vendor contacts immediately so they'll be first in line in the event of a backlog," said Hughes.