Provider Notice issued 10/01/09

Reimbursement for the H1N1 Vaccination

To receive reimbursement for H1N1 vaccine administration, providers must bill HCPCS code G9141- Influenza A (H1N1) immunization administration. In addition to reimbursement for the administration, providers may also receive reimbursement for the office visit by billing the appropriate Evaluation and Management CPT code. Since the H1N1 vaccine will be available at no cost to providers, HFS will not reimburse providers for the vaccine. Billing instructions are included with this notice.

Encounter rate clinics should only bill for the H1N1 vaccine administration when the vaccine is provided as part of a billable encounter as defined in the Handbook for Encounter Clinic Services, Topic D-210 located on the Web site at <http://www.hfs.illinois.gov/handbooks/chapter200.html>. The H1N1 vaccine administration can be billed as detail when billing an encounter. For information regarding detail billing, please refer to Example 1 in the billing instructions included with this notice.

H1N1 vaccine administration provided in an outpatient hospital setting is billable under the hospital’s fee-for-service NPI, when there is no salaried practitioner involved in the administration (billing example 2). When the client is seen by a practitioner, the office visit and H1N1 vaccine administration must be billed under the salaried practitioner’s name and NPI (billing example 1).

For information on the clinical considerations and recommendations for H1N1 flu, please use the following links:

http://www.cdc.gov/h1n1flu/

http://www.flu.gov/

http://www.idph.state.il.us/h1n1_flu/index.htm

http://www.cdc.gov/flu/swineflu/key_facts.htm

Questions regarding this notice should be directed to the Bureau of Comprehensive Health Services at

1-877-782-5565.

Theresa A. Eagleson, Administrator

Division of Medical Programs

Billing Instructions for H1N1 Vaccine

For Informational Notice of October 1, 2009

Providers are to submit charges for the evaluation and management service, the H1N1 vaccine administration, and the cost of the vaccine.  Because the H1N1 vaccine is provided to practitioners free of charge, the charge for the vaccine is to be entered as 0.00.  These services are not billable by encounter rate clinics in the absence of an otherwise billable encounter.

Example #1 Patient sees practitioner for exam, then receives the H1N1 vaccine. The department will reimburse the evaluation and management code and will separately reimburse the H1N1 vaccine administration.  Provider submits the 99xxx CPT for the evaluation and management service, G9141 for the vaccine administration, and G9142 for the H1N1 vaccine.

Example #2 Patient presents to the office/outpatient hospital for the sole purpose of H1N1 vaccine.  The department will reimburse a minimal evaluation and management service and will separately reimburse the H1N1 vaccine administration.

Example #3 Adult patient presents to the office for H1N1 vaccine, seasonal flu vaccine, and pneumococcal vaccine.  The department will reimburse a minimal evaluation and management service, the H1N1 vaccine administration, and the influenza and pneumococcal vaccines.  Additional vaccine administration charges will be rejected.

Example #4 Child presents to the office for H1N1 and other vaccines only.  The department will reimburse a minimal evaluation and management service, the H1N1 vaccine administration, and additional vaccines as usual.

Reimbursement rates can be found on our fee schedule located at: http://www.hfs.illinois.gov/feeschedule/