The h1n1 vaccine coding guidelines have been updated to include the 90470 code recently released from the american medical association (ama) for h1n1 vaccine administration
The H1N1 Vaccine Coding Guidelines have been updated to include the 90470 code recently released from the American Medical Association (AMA) for H1N1 vaccine administration. This new code or the previously communicated G9141 code can be used when billing the H1N1 vaccine administration for a CIGNA medical plan.
CIGNA will reimburse health care professionals and facilities for the administration of the H1N1 vaccine to all individuals covered under a fully-insured CIGNA medical benefit plan. CIGNA is strongly recommending all self-funded plans administered by CIGNA – where the employer makes coverage policy decisions – to also provide coverage for the administration of the vaccine.
CIGNA coverage for H1N1 vaccine administration will not be subject to plan deductibles, co-pay or coinsurance. Certain self-insured benefit plans administered by CIGNA may not adhere to this coverage policy.
The U.S. government is making the vaccine available at no cost to you; therefore CIGNA will only provide coverage for the administration of the vaccine, in accordance with the current recommendations of the Center for Disease Control (CDC) Advisory Committee on Immunization Practices (ACIP). Billing Guidelines CIGNA has developed the following billing guidelines for the prophylactic administration of the H1N1 vaccine. Facilities should use revenue code 771 with G9141 or revenue code 771 with 90470 when submitting claims for the H1N1 vaccine administration. H1N1 Only When the H1N1 vaccine is administered without the seasonal influenza vaccine, complete all steps, 1 and 2:
Bill G9141 - Influenza A (H1N1) immunization administration (includes the physician counseling the patient/family)for the administration of the H1N1 vaccine.
Bill 90470 - H1N1 immunization administration (intramuscular, intranasal), including counseling when performed
Use G9141 or 90470 to promote prompt payment as these codes will not be subject to copay or deductible and coinsurance. You may bill with either G9141 or 90470 to submit for H1N1 vaccine administration reimbursement as both codes will be processed in the same manner.
Bill V04.81 - need for prophylactic vaccination and inoculation, influenza, as the appropriate ICD-9 code. H1N1 and Seasonal Flu Vaccine When both the seasonal influenza vaccine and the H1N1 vaccine are administered to the same individual on the same date of service, complete Steps 1 – 4:
Bill G9141 - Influenza A (H1N1) immunization administration (includes the physician counseling the patient/family) for the administration of the H1N1 vaccine.
Bill 90470 - H1N1 immunization administration (intramuscular, intranasal), including counseling when performed
Use G9141 or 90470 to promote prompt payment as these codes will not be subject to the usual copay or deductible and coinsurance. You may bill with either G9141 or 90470 to submit for H1N1 vaccine administration reimbursement as both codes will be processed in the same manner.
Bill V04.81 - need for prophylactic vaccination and inoculation, influenza, as the appropriate ICD-9 code.
Bill one of the appropriate seasonal flu vaccine codes: 90655-Influenza virus vaccine, split virus, preservative free, when administered to children 6-35 months of age, for intramuscular use; 90656-Influenza virus vaccine, split virus, preservative free, when administered to individuals 3 years and older, for intramuscular use; 90657-Influenza virus vaccine, split virus, when administered to children 6-35 months of age, for intramuscular use; 90658-Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use; or 90660-Influenza virus vaccine, live, for intranasal use.
Bill one of the following administration codes for the administration of the seasonal influenza vaccine: 90466- Immunization administration younger than 8 years of age (includes percutaneous, intradermal, subcutaneous, or intramuscular injections) when the physician counsels the patient/family; each additional injection (single or combination vaccine/toxoid), per day (List separately in addition to code for primary procedure); 90468-Immunization administration younger than age 8 years (includes intranasal or oral routes of administration) when the physician counsels the patient/family; each additional administration (single or combination vaccine/toxoid), per day (List separately in addition to code for primary procedure; 90472-Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure); or 90474-Immunization administration by intranasal or oral route; each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure).
No reimbursement will be made for CPT code 90663 or HCPCS code G9142, which both represent the H1N1 vaccine product. Roster Billers Mass immunizer roster billers may submit claims for the administration of the H1N1 vaccine using the roster billing format. The above-mentioned billing guidelines must be followed and the roster must contain, at a minimum, the following information:
Patient’s date of birth, sex and CIGNA identification number;
Provider name and Tax Identification Number; and
Additional Information CIGNA also provides coverage for antiviral therapy (Tamiflu® (oseltamir) and Relenza® (zanamivir)) for individuals covered under a CIGNA Prescription Drug Plan, according to CDC guidelines. CIGNA has no precertification requirement for these antiviral drugs, but quantity limits and tiered copayments/coinsurance may apply.
Follow the current recommendations of the CDC ACIP for H1N1 vaccine administration. Refer to the CDC and Prevention website for the most current information on the H1N1 virus:
CDC Clinical & Public Health Guidance:
In addition, helpful information for your patients, including “H1N1 Virus: What You Should Know,” is available
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