Do you have queries about influenza vaccine billing or pneumonia vaccine billing? Read this post to know more.
The 2024-2025 flu season is almost here, and it’s time to proactively reach out to your patients to remind them to get their annual flu shots.
- The CDC recommends that anyone older than 6 months get the yearly flu shot.
- September and October are the best times to ask your patients to get vaccinated.
Here is all the information you will need for influenza billing for 2024-25.
Annual Flu Shots Medicare Coverage & Billing Guidelines
The good news is that Medicare Part B covers the annual flu shot. Patients can get the shot twice yearly during the two flu seasons, and Medicare covers everything if the provider accepts the assignment. There is no copayment, coinsurance, or deductible. Additional flu shots are covered where medically necessary.
The ICD-10 code for influenza vaccine billing is Z23. You can use roster billing or submit an individual claim. CMS systems will accept roster bills for one or more patients receiving the same type of vaccine on the same service date.
Roster billing provides a fast and convenient method to submit multiple claims for COVID-19, flu, and pneumococcal vaccinations. Make sure to submit each type of vaccine on a separate roster bill rather than combining different shots on a single bill.
Providers who administer COVID-19, flu, and pneumococcal vaccines to groups of people, such as those in retirement communities, are classified as mass immunizers. Mass immunizers can use a roster bill or submit a traditional claim form, like the Health Insurance Claim Form (CMS-1500) (PDF) or the 837P electronic format.
Centralized billing allows mass immunizers to submit all roster bill claims for COVID-19, flu, and pneumococcal vaccines to a single Medicare Administrative Contractor (MAC), Novitas Solutions. You can enroll and use centralized billing regardless of the vaccination site. All claims submitted through centralized billing must be in electronic format.
Medicare Payments for Flu Shots
Payment allowances and effective dates for the 2024-2025 flu season for influenza vaccine billing are as follows ( Source: CMS)
In addition to the above, here is a list of codes as per the vaccine dose and the patient’s age for influenza vaccine billing. This information is sourced from Immunize.org
Administration Codes for Influenza Vaccine
The HCPCS codes range from Vaccine Administration G0008 to G0010, a standardized code set necessary for claiming vaccine administration from Medicare and other health insurance providers. G0008 is the code for administering the influenza virus vaccine. (The administration code for the pneumococcal vaccine is G0009, and for administering the hepatitis B vaccine, the code is G0010.)
According to the American Medical Association, the Current Procedural Terminology (CPT) code 90471 is used to bill for administering a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route. This code is used when no counseling is provided during the vaccination. The service limit for this is 1 per day and can be used for patients of any age.
To conclude, informing your patients about influenza vaccination should be an annual feature of your preventative care services. For influenza vaccine billing, you must choose the code according to the manufacturer of the vaccine, the dosage, how it is supplied, the mercury content, and the age range of the patients.
If you have any further questions about influenza vaccine billing, please get in touch with us through our contact us form.
