H1N1 Only – Swin Flu
When the H1N1 vaccine is administered without the seasonal influenza vaccine, the following coding and billing guidelines should be followed:
1) Bill G9141 -Influenza A (H1N1) immunization administration (includes the physician counseling the patient/family) for the administration of the H1N1 vaccine.
Use G9141 to promote prompt payment as this code will not be subject to the usual copay or deductible and coinsurance.
2) Bill V04.81 – need for prophylactic vaccination and inoculation, influenza, as the appropriate ICD-9 code.
H1N1 and Seasonal Flu Vaccine
When both the seasonal influenza vaccine and the H1N1 vaccine are administered to the same individual on the same date of service, follow these coding guidelines:
1) Include G9141 and V04.81 as indicated above for the H1N1 vaccine administration; and
2) Bill one of the appropriate seasonal flu vaccine codes:
90655-Influenza virus vaccine, split virus, preservative free, when administered to children 6-35 months of age, for intramuscular use;
90656-Influenza virus vaccine, split virus, preservative free, when administered to individuals 3 years and older, for intramuscular use;
90657-Influenza virus vaccine, split virus, when administered to children 6-35 months of age, for intramuscular use;
90658-Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use; or
90660-Influenza virus vaccine, live, for intranasal use.
3) In addition, bill one of the following administration codes for the administration of the seasonal influenza vaccine:
90466– Immunization administration younger than 8 years of age (includes percutaneous, intradermal, subcutaneous, or intramuscular injections) when the physician counsels the patient/family; each additional injection (single or combination vaccine/toxoid), per day (List separately in addition to code for primary procedure);
90468-Immunization administration younger than age 8 years (includes intranasal or oral routes of administration) when the physician counsels the patient/family; each additional administration (single or combination vaccine/toxoid), per day (List separately in addition to code for primary procedure;
90472-Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure); or
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).
No reimbursement will be made for CPT code 90663 or HCPCS code G9142, which both represent the H1N1 vaccine product.
