Information on how to code for administration of the H1N1 vaccine.

Dear Doctor,

The H1N1 vaccine is on its way and now the question is how do I code for it?

This vaccine is provided to you for free by the government so there is no vaccine code eligible for reimbursement. A vaccine code does exist, however, there will not be any reimbursement for it. In general, if a vaccine does not have any cost, you cannot bill for the vaccine itself. However, you may bill for administration of the vaccine.

A new administration code was created by CMS last month (G9141), this is to be billed with diagnosis V04.81. Medicare reimbursement will be the same as regular flu and pneumonia vaccine administration. The commercial payer consensus seems to be to use G9141 for H1N1 administration. It is very important to use G9141 rather than other administration codes because G9141 is specific to H1N1. If you use another administration code, your claim could be denied because it will appear to be another administration of regular flu vaccine.

Another complicating factor is that another administration code was created by the AMA for the same purpose. 90470 is also a H1N1 administration code. The major payers seem to be accepting G9141, however, Medicare is not accepting 90470. Our advice is to use G9141 and to monitor for denials. Should some of the commercial payers deny the G9141, refile with 90470.

So for H1N1, bill G9141 with diagnosis of V04.81

Thanks and Have a Great Day!
Vera Loftin
Vice President
Practice Management, Improving Physician Revenue Since 1995
Golf Corporate Center
415 W. Golf Rd, Suite 16
Arlington Heights, IL 60005

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