Medicare, Two Insurers Set H1N1 Flu Vaccine Payments

The federal government is providing the H1N1 flu vaccine to health care professionals at no cost. Physicians and practitioners who vaccinate their patients won't be reimbursed for vaccine acquisition cost since it's free, but they can receive payment for administering the vaccine.

Two health plans and Medicare had determined their reimbursement policies for 2009-10 vaccine administration as of Sept 21. Medicaid hadn't yet posted its plan for paying participating physicians for H1N1 flu vaccine administration. Visit the  Texas Medicaid & Healthcare Partnership Web site for more information.

Medicare Part B beneficiaries will receive the H1N1 vaccine as an additional preventive immunization service. Medicare will pay for administering the vaccine.

These new HCPCS codes for H1N1 are effective for dates of service on or after Sept. 1:

  • G9141 - Influenza A (H1N1) immunization administration (includes the physician counseling the patient/family)
  • G9142 - Influenza A (H1N1) vaccine, any route of administration

Payment for G9141 immunization administration will be paid at the same rate established for G0008 (administration of influenza virus vaccine). H1N1 administration claims will be processed using the diagnosis V04.81 (influenza), and depending on the provider type, using revenue code 771.

More information is available from the Centers for Medicare & Medicaid Services (CMS) publication  MLN Matters No. SE0920  ( PDF ).

WellPoint had determined its H1N1 flu vaccine administration payment policy at press time. The health plan indicated it would cover the cost of vaccine administration for members whose benefit plans provide vaccine coverage. WellPoint directs policyholders who wish to confirm their benefits to call the toll-free number listed on their insurance card.

UnitedHealth Group (UHG) agreed to provide coverage for the administration of the H1N1 flu vaccine to all members covered by its insured plans. If a self-funded employer group's plan doesn't currently cover the administration of the vaccine, and the employer notifies UHG of its intent not to cover the vaccine in the future, United will reimburse the cost of the administration of the vaccine.

United indicated it would coordinate its efforts with federal and state authorities to ensure the widest possible administration of the H1N1 flu vaccine in an effort to mitigate the potential consequences of an H1N1 pandemic. The health plan set up an H1N1 frequently asked questions Web site page for members at  www.myuhc.com .

Blue Cross and Blue Shield of Texas, Humana, Aetna, and CIGNA have not yet established H1N1 flu vaccine administration payment policies.

Visit the TMA H1N1 Reimbursement Resources Web site page for further information.


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