Medicare will cover administration of both the seasonal influenza vaccine and the vaccine against 2009 pandemic influenza A(H1N1) virus.
In a notice to physicians and other health care providers, officials at the Centers for Medicare and Medicaid Services said that the same billing rules will apply to the pandemic H1N1 vaccine and the seasonal vaccine. However, because the pandemic H1N1 vaccine will be provided at no cost by the government, Medicare will pay providers only for administration.
The CMS has issued two new billing codes to address H1N1 vaccine this season. Providers can use G9141 for pandemic influenza A(H1N1) immunization administration, including physician counseling of the patient and family. Payment for G9141 will be the same as that for the administration of the seasonal influenza vaccine.
The CMS also has created a billing code, G9142, for the pandemic influenza A(H1N1) vaccine itself. However, that code will not trigger payment. Nor will Medicare pay for an office visit when its sole purpose is administration of either seasonal influenza vaccine or pandemic H1N1 vaccine.
Private insurers are also planning to extend coverage to the pandemic H1N1 vaccine.