Billing for H1N1 Vaccine Administration

When you bill for providing your patients the H1N1 vaccine, note that some health plans may require you to bill the administration code AND the H1N1 vaccine code because their claim system rejects an administration code billed alone. 

You may bill 1 cent for the vaccine code to make sure your claim is paid,  even though it is illegal to charge patients for the government-supplied vaccine. The Centers for Medicare & Medicaid Services has approved this way of billing, and does not consider it fraud. Just remember that you may not bill patients for the vaccine, and you should warn them that the 1-cent fee might appear on their insurance statement.

The TMA Influenza Web page offers a wealth of information about the H1N1 flu vaccine, including more on billing (with links to various health plans' payment policies), how to access state antiviral stocks, and H1N1 reporting requirements.



TMA Practice E-tips main page

Last Updated On

April 27, 2018

Originally Published On

March 24, 2010