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H1N1 Immunizations


With the addition of the H1N1 influenza virus to the usual seasonal flu concerns this year, we realize that this flu season is going to be different from what we've all experienced in the past. But, our goal remains the same: We want our members to stay healthy this flu season.

We're encouraging members to get their seasonal flu shots at their in-network doctor's office, from an immunizing pharmacist, or at their employer's worksite flu shot clinics. Administering providers should report H1N1 immunizations using appropriate codes G9141 or 90470 for the administration and G9142 or 90663 for the vaccine. H1N1 immunizations will be covered for eligible members with preventive care benefits - just like any other routine vaccination.

For the 2009 flu season BCBSNC is waiving out-of-pocket costs for H1N1 immunizations for all fully insured members, including those members that do not have immunization/preventive benefits; paying 100% of eligible charges for the administration of the H1N1 vaccine. In addition, some ASO(administrative services only) groups without 100% percent preventive benefits are choosing to include no-cost coverage of the H1N1 vaccination.

The U.S. Food and Drug Administration (FDA) has approved the use of one dose of 2009 H1N1 flu vaccine for persons 10-years of age and older. Priority groups should receive the 2009 H1N1 vaccine first. The Centers for Disease Control and Prevention (CDC) list these groups as:

  • Pregnant women
  • People who live with or provide care for infants less than 6-months of age
  • Health care and emergency medical services personnel
  • Adults ages 25 to 64-years with medical conditions that put them at higher risk for influenzarelated
    complications
  • Children and young adults ages 6-months to 24-years
    • The CDC recommends that children younger than nine who are being vaccinated against
      influenza for the first time receive two doses. Doses of 2009 H1N1 vaccine should be
      separated by 4 weeks when administered to children younger than nine, however, if the
      second dose is separated from the first dose by at least 21 days, the second dose can
      be considered valid.
    • The CDC considers infants younger than six-months of age too young to get the 2009
      H1N1 and seasonal flu vaccines.

Additional guidance about the 2009 H1N1 Flu and H1N1 immunizations is available from the Centers for Disease Control and Prevention on Web at http://www.cdc.gov/h1n1flu/.

The 2009 H1N1 vaccine does not replace a member's seasonal flu vaccine


H1N1 - Influenza immunization billing
Applies to all product lines administered by BCBSNC


Administration
Codes
Code Descriptor Filing Instructions
G9141 Influenza A (H1N1) immunization administration
(includes the physician counseling the
patient/family)
Code G9141 should only be
used to report H1N1
immunization administration
90470 H1N1 immunization administration
(intramuscular, intranasal), including counseling
when performed
Code 90470 should be used to
report H1N1 immunization
administration
Vaccine Codes Code Descriptor Filing Instructions
G9142 Influenza A (H1N1) vaccine, any route of
administration (includes IM, SQ, and intranasal
administration of vaccine)
Code G9142 should only be
used to report H1N1 vaccine
Claims should be reported with
a zero charge for this code
90663 Influenza virus vaccine, pandemic formulation
H1N1
Code 90663 should be used to
report H1N1 immunization
administration
Claims should be reported with
a zero charge for this code
Diagnosis Code
BCBSNC will recognize diagnosis code V04.81 (influenza) for H1N1 immunization claims, the same code
being recognized by the Centers for Medicare & Medicaid Services (CMS) as outlined in the MLN Matters®
article SE0920: http://www.cms.hhs.gov/ContractorLearningResources/downloads/JA0920.pdf.
Coverage
BCBSNC offers coverage for H1N1 vaccine administration. However, some ASO members may be
responsible for any applicable copayment, deductible and/or coinsurance payments.
Bundling
Providers should not bill CPT code 99211 with a vaccine administration code unless a separately
identifiable service is also provided, in which case a -25 modifier should be appended. Without
appending modifier -25, code 99211 will not be considered for payment separately from the vaccine
administration code.
Reimbursement
The government is providing H1N1 vaccine to providers free of charge; therefore reimbursement should
not be requested (vaccine codes should be filed with a zero charge). Payment should be requested only
for the vaccine administration service. Administration costs reported with the newly assigned HCPCS
code G9141 will be reimbursed at a minimum equivalency to that of a provider’s BCBSNC contractual
rate for administrative service code CPT 90471.

ASO groups that do not have immunization/preventive benefits can opt-in to cover the cost of H1N1 immunizations at 100% percent of eligible charges for employees and their dependents. Members with preventive care benefits, who are enrolled as part of an ASO group plan that has not elected 100% first dollar coverage will be responsible for any applicable copayment, coinsurance and/or deductible amounts. However, these same ASO members will pay no copayments when receiving immunizations at an in-network physician's office or in-network CVS Minute Clinics, if the flu shot is the only service received. ASO members with preventive care benefits but without 100% first dollar coverage, who receive immunizations at in-network ERs and urgent care centers, may be responsible for ER or urgent care copayment, coinsurance and/or deductible amounts, depending on their individual benefit plans.