Vaccination

An exemption has been granted from California Health and Safety Code Section 124172 subdivision (a) for influenza A (H1N1) 2009 monovalent influenza vaccine administered to children younger than 3 years old and pregnant women for the period of October 12, 2009 – November 30, 2009.

The American Medical Association (AMA) has announced two new Current Procedural Terminology (CPT) codes, effective immediately, for reporting the H1N1 vaccine and administration. The codes are as follows: 90470 H1N1 immunization administration, including counseling when performed, 90663 Influenza virus vaccine, pandemic formulation, and H1N1.  The Centers for Medicare & Medicaid (CMS) also created two HCPCS codes: G9141 Influenza A (H1N1) immunization administration (includes the physician counseling the patient/family), G9142 Influenza A (H1N1) vaccine, any route of administration.

CMS typically adopts published CPT codes, known as Medicare HCPCS Level I codes. In this case, CMS released their own set of H1N1 codes prior to the published AMA CPT codes. The California Hospital Association has brought to the attention of CMS that there are now two sets of H1N1 codes which could create billing confusion for providers. At this time, CMS has advised providers use the CMS HCPCS codes (G9141 and G9142) for Medicare billing until further notice.

The following links include the AMA and CMS fact sheets for H1N1 billing:

• AMA H1N1 Reporting Fact Sheet