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January 25, 2018

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Medical Coding News Archives

AMA/CMS Release Different Coding Advice for H1N1 Vaccinations

September 10, 2009:

The American Medical Association (AMA) has posted on its website coding advice on how to report the H1N1 (swine flu) vaccine and administration. According to the AMA, code 90663 is the appropriate code for reporting H1N1 vaccine administration.

90663  Influenza virus vaccine, pandemic formulation

The appropriate administration code from range 90465–90474 may also be reported in conjunction with code 90663. The appropriate administration code depends on the age of the patient and route of administration.

The Centers for Medicare & Medicaid Services (CMS) has created two new HCPCS codes for H1N1, effective for dates of service on and 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

Payment for G9141 immunization administration, will be made at the same rate established for G0008 Administration of influenza virus vaccine. H1N1 administration claims will be processed using diagnosis code V04.81 Influenza, and, depending on the provider type, revenue code 771. The same billing rules apply to the H1N1 virus vaccine as the seasonal influenza virus vaccine with one exception. Because the H1N1 vaccine will be made available at no cost to providers, Medicare will not pay providers for the vaccine. Providers do not need to place G9142 on the claim; however, if G9142 appears on the claim, only the claim line will be denied.

The Center for Disease Control (CDC) has issued recommendations that the following groups be vaccinated:

  • Pregnant women due to the increased risk of complications and potential protection to infants who cannot be vaccinated
  • Caregivers and contacts for children younger than 6 months of age since younger infants are at higher risk of influenza-related complications and cannot be vaccinated
  • Health care and emergency medical services personnel since infections among health care workers have been reported and can be a potential source of infection for vulnerable patients
  • All people from six months through 24 years of age
    • Children from six months through 18 years of age because there have been many cases of novel H1N1 influenza reported in children and children are often in close contact with each other in school and day care settings
    • Young adults 19 through 24 years of age because there have been many cases of novel H1N1 influenza in these healthy young adults and this population often lives, works, and studies in close proximity. Additionally, young adults often are a mobile population
  • Persons aged 25 through 64 years who have health conditions associated with higher risk of medical complications from influenza

Deborah C. Hall
Clinical Technical Editor


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