« Back to News List

Billing for the Administration of the Influenza A (H1N1) Virus Vaccine

December 02, 2009

BlueCross BlueShield of South Carolina provides coverage for the seasonal influenza virus vaccine and its administration as part of its preventive immunization services. We will pay for the administration of the seasonal flu vaccinations even if the vaccinations are rendered earlier in the year than normal. Typically payment is warranted for one vaccination per year. We cover additional influenza vaccines (i.e., the number of doses of a vaccine and/or the type of influenza vaccine) when they are deemed to be medical necessary. If it is necessary for our members to receive both seasonal flu vaccinations and Influenza A [H1N1] vaccinations, then we will pay for the administration of both vaccines.

Effective September 1, 2009, BlueCross BlueShield of South Carolina will pay for the administration of H1N1and the seasonal flu vaccination for all its fully insured members. 
 
BlueCross will cover the administration of H1N1 and seasonal flu vaccination depending on the member’s preventive benefits. 

  • If the member has preventive benefits, we will cover the H1N1 administration and vaccine for the seasonal flu shot at 100 percent with no age limits, deductible, coinsurance, copayment, etc.
  • If the member does not have preventive benefits, BlueCross will cover the administration of H1N1 and the administration of the seasonal flu shot subject to the member’s deductible, coinsurance or copayment.

Payment will not be made to providers for the office visit when the only purpose of the visit is to administer the seasonal and/or the H1N1 vaccine(s).

Vaccination Payments

Payment for G9141, 90470 or 90473 (administration of H1N1, which includes physician counseling the patient/family) and G0008 (administration of the seasonal influenza vaccine) will be paid at the same rate of $3.00 established for 90471 (immunization administration including percutaneous, intradermal, subcutaneous or intramuscular injections). 

Filing H1N1 Vaccine Claims

Effective for dates of service on and after September 1, 2009, the following codes can be used to file claims for H1N1:

  • G9141 or 90470 – Influenza A (H1N1) immunization administration (includes physician counseling the patient/family)
  • 90473 – Immunization administration by intranasal or oral route; one vaccine single or combination vaccine/toxoid.
  • G0008 – Administration of the seasonal influenza vaccine
  • G9142 or 90663 – Influenza A (H1N1) vaccine, any route of administration

The H1N1 vaccine serum, syringes and needles will be paid for by the federal government and provided to state health departments which will be responsible for creating a distribution model for providing the vaccine in local communities.
 
Since the H1N1 vaccine will be made available at no cost to providers, BlueCross will not pay providers for the vaccine, only the administration. Providers do not need to place the G9142 or 90663 (H1N1 vaccine code) on the claim. If either the G9142 or 90663 code appears on the claim, only that claim line will be denied.

Vaccine Administration and Dosage Schedule

Here is the most recent information available on the recommended vaccine dosage and administration:
 

Age  Type of Administration  Dosage 
Children ages 2-9 years  Mist  2 – 0.2 mL doses (each 0.2 mL dose is administered as 0.1 mL per nostril) approximately one month apart 
Children, adolescents and adults ages 10-49 years  Mist  1 - 0.2 mL dose (each 0.2 mL dose is administered as 0.1 mL per nostril) 
Children 6-35 months  Injection  2 – 0.25 mL intramuscular doses approximately one month apart 
Children 36 months - 9 years  Injection  2 – 0.5 mL intramuscular doses approximately one month apart 
Children, adolescents and adults ages 10 and older  Injection  1 – 0.5 mL intramuscular dose 
 
We understand that such preparations are critical for the upcoming flu season, especially in planning for the Influenza A [H1N1] vaccine. We will continue to provide you with the most current information about this subject.
 

« Back to News List