 | On June 11, 2009, the World Health Organization (WHO) declared the novel H1N1 flu virus (swine flu) to be a worldwide pandemic. In response to this outbreak, several new monovalent flu vaccines have been developed and approved by the US Food and Drug Administration (FDA). The FDA recommends that children (6 months to 9 years of age) should be administered two doses of the novel H1N1 monovalent flu vaccine, with 21-28 days between the first and second vaccination. Adults and children 10 years of age and older should be administered one dose of the novel H1N1 monovalent flu vaccine.
According to the Centers for Disease Control and Prevention (CDC), the novel H1N1 flu vaccine will be made available to healthcare professionals at no cost starting in October. The vaccine will be available in a combination of settings, such as vaccination clinics organized by local health departments, healthcare provider offices, and other private settings (eg, pharmacies, workplaces). Private providers wishing to administer the novel H1N1 flu vaccine may be able to enter into relationships with their public health departments to determine distribution options. However, because the CDC has announced that the vaccine will be supplied at no cost, the Company will only provide reimbursement for the administration of the novel H1N1 flu vaccine, not the vaccine itself.
PROVIDER REIMBURSEMENT
The vaccine and the associated supplies are being provided by the Federal Government at no cost and, therefore, will not be eligible for separate reimbursement.
Use one of the following codes to report the administration of the novel H1N1 flu vaccine:
- 90470: H1N1 immunization administration (intramuscular, intranasal), including counseling when performed
- G9141: Influenza A (H1N1) immunization administration (includes the physician counseling the patient/family)
Copayments should not be collected for the vaccine or administration. Additionally, an office visit evaluation and management (E&M) code should not be billed unless the individual is being treated for a separately identifiable medical problem or service. If an office visit E&M is being performed, applicable copayment requirements may apply.
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