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Billing for the Administration of the Influenza A (H1N1) Virus Vaccine under the State Health Plan

January 26, 2010

Effective September 1, 2009, State Health Plan will pay for the administration of the Influenza A (H1N1) Virus Vaccine for all its State members at 100% with no age limit, deductible, coinsurance, copayment, etc.
 
Payment will not be made to providers for the office visit when the only purpose of the visit is to administer the seasonal and/or the H1N1 vaccine(s).
 
For seasonal influenza, State Health Plan will pay for the vaccine and administration for children ages 6 months through 18 years of age under the Standard Plan.
 
Coverage for seasonal influenza vaccine and administration under State Health Plan’s Savings Plan begins at age 6 months.

Vaccination Payments

Payment for G9141, 90470 or 90473 (administration of H1N1, which includes physician counseling the patient/family) and G0008 (administration of the seasonal influenza vaccine), will be paid at the same rate of $4.00 established for 90471 (immunization administration including percutaneous, intradermal, subcutaneous or intramuscular injections).

Vaccination Codes

Filing H1N1 Vaccine Claims
Effective for dates of service on and after September 1, 2009, the following codes can be used to file claims for H1N1:

  • G9141 or 90470 —Influenza A (H1N1) immunization administration (includes physician  counseling the patient/family)  
  • 90473 - Immunization administration by intranasal or oral route; one vaccine single or combination vaccine/toxoid.
  • G0008 – Administration of the seasonal influenza vaccine
  • G9142 or 90663 —Influenza A (H1N1) vaccine, any route of administration
The H1N1 vaccine serum, syringes and needles will be paid for by the federal government and provided to state health departments which will be responsible for creating a distribution model for providing the vaccine to local communities.
 
Since the H1N1 vaccine will be made available at no cost to providers, State Health Plan will not pay providers for the vaccine, only the administration. Providers do not need to place the G9142 or 90663 (H1N1 vaccine code) on the claim. If either the G9142 or 90663 code appears on the claim, however, only that claim line will be denied.

Vaccine Administration and Dosage Schedule

Here is the most recent information available on the recommended vaccine dosage and administration:
 

Age
 Type of Administration  Dosage 
Children age 2-9 years  Mist  2 – 0.2 mL doses (each 0.2 mL dose is administered as 0.1 mL per nostril) approximately one month apart
Children, adolescents and adults age 10-49 years  Mist  1 - 0.2 mL dose (each 0.2 mL dose is administered as 0.1 mL per nostril)
Children 6-35 months  Injection  2 – 0.25 mL intramuscular doses approximately one month apart
Children 36 months-9 years  Injection  2 – 0.5 mL intramuscular doses approximately one month apart
Children, adolescents and adults age 10 and older  Injection  1 – 0.5 mL intramuscular dose




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