Bulletin: September 10, 2009
H1N1 Vaccine
The Centers for Medicare & Medicaid Services (CMS) have created two new HCPCS Codes in preparation for the availability of a vaccine for the H1N1 virus this fall. The effective date of G9141 (Influenza A (H1N1) immunization administration) and G9142 (Influenza A (H1N1) vaccine, any route of administration) is September 1, 2009.
Special billing procedures must be followed for Medicare Outpatient Hospital claims since the effective date is earlier than originally anticipated and CMS is not yet ready to accept the new codes.
If you administer the vaccine between September 1, 2009, and September 30, 2009:
- Submit outpatient claims omitting HCPCS Codes G9141 and G9142.
- Once you receive payment for the outpatient claim, immediately submit an adjustment request (TOB=XX7), this time including G9141 and G9142 or G9141 only.
Adjustment requests containing G9141 and G9142 or G9141 only with dates of service between September 1 and September 30, 2009 will be held until the January 2010 Integrated Outpatient Code Editor (IOCE) software release is implemented. After that time, all held adjustment requests will be released for processing.
This issue will not impact claims with dates of service after September 30, 2009.
For more information, see:
- Medicare Part B instructions http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0920.pdf
- Medicare Part A instructions http://www.medicarenhic.com/whats_new/ne_whats_new.shtml and http://www.cms.hhs.gov/transmittals/downloads/R1803CP.pdf