During this challenging influenza season, new billing codes have been developed for the administration of the H1N1 vaccine. Medicare will pay physicians for administering the H1N1 vaccine this year, including when it’s given to patients who also receive the seasonal influenza vaccine. But the agency won’t reimburse physicians for the actual H1N1 vaccine because the vaccine will be supplied to providers for free.

To bill Medicare for administering the H1N1 vaccine, use code G9141 (influenza A, H1N1, immunization administration—including counseling the patient or family). It is not necessary to place the H1N1 vaccine code (G9142) on the claim. For more information on Medicare coverage and reimbursement rules for the H1N1 and seasonal influenza vaccines, see this CMS fact sheet and related article.  

The American Medical Association (AMA) has also developed a current procedural terminology (CPT) vaccine administration code, 90470, specific to the 2009 H1N1 virus, and revised existing code 90663 to report either the intranasal or intramuscular formulations of the H1N1 virus.  For purposes of safety tracking, it has been requested that National Drug Codes (NDCs) be added to the claim sheet.  For more information about CPT codes for the H1N1 vaccine, see this AMA webpage and fact sheet. While many private payers are likely to cover administration of the vaccine using these codes, physicians should contact individual insurers for specific billing instructions.

To obtain a supply of the H1N1 vaccine, physician offices will need to contact their state health departments. See the Centers for Disease Control and Prevention (CDC) for a list of state contacts.

For other questions about CPT coding, use IDSA’s “Ask the Coder” e-mail portal to contact a certified professional coder. (You must be logged in to access this link.)

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