New CPT Codes for H1N1 Immunizations

The AMA, working with the US Department of Health & Human Services (HHS), has expedited the publication of new health care codes specific to the H1N1 vaccine product. The new Category 1 Current Procedural Terminology (CPT) codes issued by the AMA will streamline the reporting and reimbursement procedure for physicians and health care providers who are expected to administer nearly 200 million doses of the H1N1 vaccine in the United States. The codes will also help in reporting and tracking immunization and counseling services related to the H1N1 vaccine throughout the health care system.

In consultation with HHS, the AMA CPT Editorial Panel are utilizing two codes for H1N1:

  • Code 90470 to report H1N1 immunization administration and counseling;
  • Code 90663 was revised by the CPT Editorial Panel to refer specifically to the H1N1 vaccine product.

Both revised code 90663 and 90470 are effective immediately. For more H1N1 information, see http://www.ama-assn.org/go/h1n1.

In addition, CMS has developed two new codes for H1N1 immunizations for the Medicare program:

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

CMS says the H1N1 vaccine will be provided free of charge to immunizers. For H1N1 vaccine administration, Medicare will pay the same rate as it does for administering seasonal flu vaccine, about $21. In addition, for both seasonal flu and H1N1 vaccine administration, Medicare will pay 100%, and patients will not be charged any co-pays or deductibles. Federal HHS has also asked private insurers to provide first-dollar coverage of H1N1 vaccine administration.

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