96372

This injection code is being denied by Medicare when flu vaccine is administered. Is there a modifier that should be used?

H1n1

Medicare Part B provides coverage for seasonal influenza virus vaccine and its administration as part of its preventive immunization services. The Influenza A (H1N1) virus has been identified as an additional type of influenza. Medicare will pay for the administration of the H1N1 vaccine.
The following new HCPCS codes for H1N1 are effective for dates of service on or 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.
Diagnosis code V04.81

96372

Medicare is denying the injection code 96372 when charging for the flu shot (code 90658)

H1n1

CMS created HCPCS codes G9142 for the vaccine itself, which is not payable by Medicare as it will be supplied at no cost to providers, and HCPCS code G9141 for the administration, which is payable.

96372

Thanks for the information

96372

Aren't you lucky to have H1N1 vaccine to give. I can't even find a seasonal flu shot!

If you type "H1N1" into the search box above "look it up" you'll find an article about the topic.

96372

Hi Diane,

When submitting the seasonal flu vaccine (90658) to Medicare, you need to use G0008 as the administration code. They will not pay the administration with code 96372.

Hope this helps.
Donna

96372

Thank you so much! That is exactly what I needed.
Diane

re: 96372

When patient comes in for flu shot (Q2038 medicare) and also a B-12
subq injection, do I need a 59 on the G0008 giving of the flu shot?

re: 96372

Medicare B12: https://www.cgsmedicare.com/hhh/coverage/HH_Coverage_Guidelines/7D.html
No, to 59 modifier