H1N1 Vaccine Reporting Codes in CPT®

The American Medical Association (AMA) has created a new CPT^® code specific to vaccine administration and revised an existing code to include the H1N1 vaccine.

“The new CPT^® code will streamline the reporting and reimbursement procedure for physicians and health care providers who are expected to administer nearly 200 million doses of the H1N1 vaccine in the United States,” the AMA states in an Oct. 2 eVoice report. “The codes also will help efficiently report and track immunization and counseling services related to the H1N1 vaccine throughout the health care system.”

Use newly created code 90470 H1N1 immunization administration (intramuscular, intranasal), including counseling when performed to report H1N1 immunization administration and counseling. Use revised code 90663 Influenza virus vaccine, pandemic formulation, H1N1 to report the H1N1 vaccine product.

Both revised codes 90663 (still pending FDA approval) and 90470 are effective immediately.

Related posts:

1. Prepare for the H1N1 Vaccine Rush
2. H1N1 Vaccine HCPCS Codes Released
3. Initial H1N1 Vaccine Not for Everyone
4. New Codes, Rules Add Specificity to Flu Reporting
5. Know Carrier Guidelines When Coding H1N1

10 Responses to “H1N1 Vaccine Reporting Codes in CPT®”

1. Mary Klaus Says:
   October 7th, 2009 at 9:17 am

   Are these codes for all Insurances, including Medicare? Their publication all say that the code to use for the administration is G9141 and G9142. We are not sure what to bill. Thanks

   Mary Klaus

2. Annie Shoffit Says:
   October 7th, 2009 at 10:03 am

   You would use the G9141 for just Medicare, and possible BC/BS, depending on you carriers requirement. When doing a flu swab, you do not have to use a screening code. You can use symptoms, such as fever, cough, sore throat, body aches, headache…

3. Renelle Says:
   October 7th, 2009 at 11:01 am

   I would check with each individual carrier. In my area (NY downstate), there are many commercial carriers that will accept both G9141 & 90470 for the admnistration.

4. Judy Habetler Says:
   October 7th, 2009 at 11:37 am

   I was just informed by one of my physicians that the correct coding schema for billing H1N1
   administration code 90470 with an administration of another vaccine on the same day would
   be to bill the additional code for the administered vaccine (ie mmr) and code 90472 as the 90470
   takes the place of 90471 in this scenario. Does anyone have clarification of this?? Thanks Judy Habetler

5. Ashley C Says:
   October 7th, 2009 at 12:29 pm

   My recommendation is to poll each of your payers. So far (here in FL) we are being instructed by most of our carriers, including commercial, to use G9141 versus 90470.

6. Marjorie Giardina Says:
   October 8th, 2009 at 6:24 am

   Do we use the v04.81 code with the G9142 code when reporting administration of H1N1 vaccines. If not, which dx code is appropriate to use with the H1N1 vaccine?

7. Tracy Says:
   October 8th, 2009 at 9:28 am

   What about pricing on this code. Does anyone know if the reimbursement is going to be in the same range as the influenza immunization/vaccine?

8. SUSAN MARINO Says:
   October 8th, 2009 at 11:58 am

   Some of the carriers require 90663 for the H1N1 vaccine billed at .01 with the administration code. Physicians desk reference identifies this as intramuscular. Is it also used for H1N1 Flu mist?

9. KIM CULP Says:
   October 9th, 2009 at 8:00 am

   Does anyone have an idea of the average rate payors are going to reimburse for the admin of the H1N1 vac, or if the coinsurance and deductibles will apply?

   Thanks
   Kim

10. Marita Says:
    October 10th, 2009 at 8:40 am

    To Kim Culp:Mcare will pay G9141 at same rate as current G0008 without applying ded and coinsurance. Don’t know what other payers will do.

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