Influenza, Are You Billing Correctly?

January 31st, 2018 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
Categories:   Allergy|Immunology   CPT® Coding   Primary Care|Family Care  
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With this year's Flu season being the most widespread on record, providers are seeing more patients and giving more immunizations for influenza than normal. Here are a few things to keep in mind during this flu season. 

Know the rules with your payers to ensure proper reimbursement and correct billing. For example, did you know the Seasonal influenza virus and pneumococcal vaccines and their administration are covered with Part B benefits and not Part D benefits under Medicare?

Medicare will pay for both administration fees for seasonal influenza and pneumococcal vaccines on the same day, report G0009 for Influenza and G0009 for Pneumococcal.   

Other Medicare Tips

  • All physicians, non-physician practitioners (NPPs), and suppliers who administer the seasonal influenza virus and the pneumococcal vaccines must accept assignment on the claims for the vaccines.
  • Enrolled providers may roster bill for seasonal influenza virus and pneumococcal vaccinations even if they are not a mass immunizer.
  • Neither the Part B deductible nor coinsurance or co-payment applies to the seasonal influenza virus, or their administration from physicians or suppliers that agree to accept assignment.
    • A mass immunizer offers influenza virus vaccinations, pneumococcal vaccinations, or both to a group of individuals.
    • Roster billing is a simplified billing process that allows mass immunizers to submit one claim form with a list of several immunized beneficiaries. 
    • Centralized billing allows mass immunizers, who operate in at least three payment localities served by at least three different Medicare Administrative Contractors (MACs), to send all influenza virus and pneumococcal vaccination claims to a designated MAC.

A new code was released in July 2017 for implementation on January 1, 2018, for quadrivalent (ccIIV4).

NEW Code: 90756  Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, antibiotic free, 0.5 mL dosage, IM.   Prior to that HCPCS, Q2039 was used for reporting  Influenza virus vaccine, nos. 

When reporting the encounter be sure to report the correct Z encounter code Z23, encounter for immunization.

Because vaccines are commonly administered at preventative visits you may need to report the E/M code with a modifier 25.   Be sure to verify with the payers you use, to ensure their coding requirements

Administration Codes

90460

 Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first or only component of each vaccine or toxoid administered

Primary code that can be used with the following Add-on codes-

90461

Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; each additional vaccine or toxoid component administered (List separately in addition to code for primary procedure)

Add-on Code, may be used in addition if applicable- Non-Medicare reporting

90472

Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); each additional vaccine (single or combination vaccine/toxoid) (List separately in addition

Add-on Code, may be used in addition if applicable- Non-Medicare reporting

90474

Immunization administration by intranasal or oral route; each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure)

Add-on Code, may be used in addition if applicable- Non-Medicare reporting

G0008

Administration of influenza virus vaccine

Medicare requires the use of  a HCPCS code to bill administration for all influenza vaccines

Vaccines

90630

Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, for intradermal use

90645

Hemophilus influenza b vaccine (Hib), HbOC conjugate (4 dose schedule), for intramuscular use

90646

Hemophilus influenza b vaccine (Hib), PRP-D conjugate, for booster use only, intramuscular use

90648

Haemophilus influenzae type b vaccine (Hib), PRP-T conjugate, 4 dose schedule, for intramuscular use

90653

Influenza vaccine, inactivated (IIV), subunit, adjuvanted, for intramuscular use

90654

Influenza virus vaccine, trivalent (IIV3), split virus, preservative-free, for intradermal use

90655

Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.25 mL dosage, for intramuscular use

90656

Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.5 mL dosage, for intramuscular use

90657

Influenza virus vaccine, trivalent (IIV3), split virus, 0.25 mL dosage, for intramuscular use

90658

Influenza virus vaccine, trivalent (IIV3), split virus, 0.5 mL dosage, for intramuscular use

90660

Influenza virus vaccine, trivalent, live (LAIV3), for intranasal use

90661

Influenza virus vaccine, trivalent (ccIIV3), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use

90662

Influenza virus vaccine (IIV), split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use

90663

Influenza virus vaccine, pandemic formulation, H1N1

90664

Influenza virus vaccine, live (LAIV), pandemic formulation, for intranasal use

90666

Influenza virus vaccine (IIV), pandemic formulation, split virus, preservative free, for intramuscular use

90667

Influenza virus vaccine (IIV), pandemic formulation, split virus, adjuvanted, for intramuscular use

90668

Influenza virus vaccine (IIV), pandemic formulation, split virus, for intramuscular use

90672

Influenza virus vaccine, quadrivalent, live (LAIV4), for intranasal use

90673

Influenza virus vaccine, trivalent (RIV3), derived from recombinant DNA, hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use

90674

Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use

90682

Influenza virus vaccine, quadrivalent (RIV4), derived from recombinant DNA, hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use

90685

Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.25 mL dosage, for intramuscular use

90686

Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.5 mL dosage, for intramuscular use

90687

Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.25 mL dosage, for intramuscular use

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