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POLICYA vaccine for the H1N1 swine flu is being released by the Centers for Disease Control and Prevention (CDC).
Due to the limited supply of the H1N1 vaccine, the Mississippi State Department of Health (MSDH) has established the 2009 Influenza A (Novel H1N1) Swine Flu Vaccine Provider Agreement. Only those providers who sign and agree to administer the H1N1 vaccine according to federal guidelines and to specific groups based on health risk via the MSDH 2009 Influenza A (Novel H1N1) Swine Flu Vaccine Provider Agreement will have access to the vaccine.
If you are a provider who has agreed to the 2009 Influenza A (Novel H1N1) Swine Flu Vaccine Provider Agreement, the following coding guidelines apply.
The American Medical Association has issued CPT codes for the administration of the swine flu vaccine and revised an existing code to include the swine flu vaccine. These codes are 90470 (H1N1 immunization administration (intramuscular, intranasal), including counseling when performed) and 90663 (Influenza virus vaccine, pandemic formulation, H1N1).
Additionally, the Centers for Medicare and Medicaid Services have created two new HCPC codes related specifically to the H1N1 vaccine. These codes are G9141 (Influenza A (H1N1) Immunization administration (includes the physician counseling the patient/family) and G9142 (Influenza A (H1N1) vaccine, any route of administration).
Blue Cross & Blue Shield of Mississippi (BCBSMS) will not provide reimbursement for the vaccine as this cost of the vaccine will be covered by the federal government.. However, reimbursement will be provided for the administration fee of the vaccine for the nasal mist version and the injection version of the vaccine under Healthy You!.
CODING AND CLAIMS FILING GUIDELINES FOR H1N1 VACCINE ADMINISTRATION
When filing for reimbursement of the administration of the H1N1 vaccine, only the administration code for the vaccine should be submitted with diagnosis code V04.81 (need for prophylactic vaccination and inoculation, influenza) using one of the following codes:
If the code for the vaccine is submitted (90663 or G9142), it will be rejected. The member is not responsible for this charge and you cannot bill the member for the vaccine.
POLICY EXCEPTIONSThe coding guidelines outlined in Coding Policy should not be used in lieu of the Member's specific benefits plan language.
POLICY GUIDELINES9/2009: Policy developed