Influenza, Are You Billing Correctly?

January 31st, 2018 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS

Categories: Allergy|Immunology CPT^® Coding Primary Care|Family Care

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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