Billing for the Administration of Influenza A (H1N1) Vaccine

on Wednesday, 07 October 2009. All News Items

Medicare will cover the administration of the H1N1 flu vaccine in addition to coverage of the regular seasonal influenza vaccine and its administration.  Two new HCPCS codes have been created for the H1N1 influenza vaccine, effective for dates of service on and after September 1, 2009:

  • G9141—Influenza A (H1N1) immunization administration (includes the physician counseling the patient/family)
  • G9142---Influenza A (H1N1) vaccine, any route of administration

HCPCS code G9141 has an OPPS payment rate of $24.89 for CY 2009 and beneficiary co-payment and deductible do not apply.  Providers should report one unit of HCPCS code G9141 for each administration of the H1N1 vaccine using diagnosis code V04.81 and revenue code 771.  Providers who normally roster bill for immunizations may submit H1N1 administration claims using the roster billing format.  The same roster billing information is required as for seasonal influenza roster claims.

Payment will not be made for HCPCS code G9142 (status indicator ‘E’ under OPPS) since the H1N1 vaccine will be supplied to providers at no cost.  Providers do not need to submit G9142 on the claim, but if it appears on the claim, only the line item will deny.

Since the H1N1 vaccine was released earlier than anticipated, the October IOCE contained an effective date for the new HCPCS codes of October 1, 2009.  The effective date will be corrected to September 1, 2009 with the January IOCE update.  Claims for H1N1 vaccine administration in September 2009 will be held until the installation of the January IOCE release.

Additional information on Medicare coverage of H1N1 and seasonal influenza vaccines can be found at MLN Matters Article SE0920 and MLN Matters Article MM6626.

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