Now that we are full in to flu season, you may have begun administering the H1N1 Vaccine. CMS has created an HCPCS code specifically for reporting the administration of this vaccine. Providers are instructed to bill using code G9141. Payment is the same as that for seasonal flu vaccine. CMS also has a code for the drug itself, G9142, however since this is not a payable code, it is not required to be included with your claim submission.

Private insurers are not required to use the G code, but many will accept it. Others may have different guidelines. Many private insurers ask that providers use the standard CPT code for the administration of H1N1 vaccine. According to the American Medical Association's website, CPT 90470 (H1N1 immunization administration (intramuscular, intranasal) has been created for the administration of H1N1. To indicate the vaccine itself, you should include CPT code 90663, even though this is not a payable code.

For more information, visit the AMA website.

Labels: flu vaccine, H1N1 vaccine, how to get paid for H1N1 vaccine