General Information

H1N1 Vaccine – Billing and Coverage Information

In anticipation of the availability of a vaccine for the H1N1 virus in the fall of 2009, the Centers for Medicare & Medicaid Services (CMS) created two new HCPCS Codes for the vaccine itself (G9142), which is not payable by Medicare as it will be supplied at no cost, and for the administration (G9141), which is payable. The effective date of G9142 and G9141 is September 1, 2009.

Specific Instructions from Palmetto:
Since the effective date of the H1N1 codes is earlier than expected, Palmetto has advised that providers follow the billing procedures outlined below if the H1N1 vaccine is administered between September 1, 2009 and September 30, 2009:

  • Submit outpatient claims omitting HCPCS Codes G9141 and G9142.
  • Once you receive payment for the outpatient claim, immediately submit an adjustment request (TOB = XX7) including G9141 and G9142, or G9141 only.
  • Adjustment requests will be held until the January 2010 Integrated Outpatient Code Editor (IOCE) software release is implemented.


For additional billing and coverage information related to the administration of the Influenza A (H1N1) Virus Vaccine please see the following MLN Matters Report (SE0920). Link: www.cms.hhs.gov/MLNMattersArticles/downloads/se0920.pdf

 

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