How do I bill Medicare with a flu shot?
You may use roster billing format, or submit individual claims using the CMS-1500 form (PDF) or the 837P electronic format. CMS systems will accept roster bills for 1 or more patients that get the same type of shot on the same date of service.
How do you bill G0008 and 90471 together?
For vaccines given the same day as a G-Code vaccine, use 90471. For example, if a patient receives a flu shot and tetanus shot, you would bill G0008 for the flu vaccine and 90471 for the tetanus vaccine; also add modifier 59 (distinct procedural service) to the G code.
What is the administration code for flu vaccine for Medicare?
For Medicare patients, use the administration code G0008. For non-Medicare patients: If the patient receiving the influenza vaccine is 18 years of age or younger and receives counseling from a physician or other qualified health care professional (e.g., nurse practitioner), report 90460.
Can we bill CPT 90471 to Medicare?
You would have to use 90471 because G0008 is not a primary code for 90472. Also remember, Medicare doesn't pay for vaccinations outside of the flu, pneomoccocal and HepB. They will pay for tetanus if there is a medical reason for it, but not just a preventative vaccination.
Does Medicare pay for CPT code G0008?
Use separate administration codes for the seasonal influenza virus (G0008) and pneumococcal (G0009) vaccines. Medicare pays both administration fees if a beneficiary gets both the seasonal influenza virus and the pneumococcal vaccines on the same day.
Does CPT G0008 require a modifier?
Expert. Francynesmith said: I too was told the same thing by Medicare - G0008 must have a modifier when billed with multiple vaccines.
What modifier can be used with 90471?
If 90471 does not represent a duplicate of the service described by HCPCS code, modifier 59 may be to the 90471 code. In addition a diagnosis code specific to the disease for which the prophylactic vaccine is being administered, it should be linked to 90471.
What is the Medicare code for 90471?
90471 One vaccine, single or combination vaccine/toxoid. Immunization administration (includes percutaneous, intradermal, subcutaneous or intramuscular injections).
Can 90471 and 90474 be billed together?
You can mix and match 90460-90461 and 90471-90474 if the provider counsels the patient on some, but not all, of the vaccines or vaccine/toxoid components administered.
What is the difference between 90460 and 90471?
The 90460 code is used when a physician is present and performs face-to-face counseling to the caregiver or parent. This code can only be used for patients through age 18. Code 90471 is used when the drug is administrated by a medical assistant or nurse and the patient does not see the physician at all.
What is a GY modifier used for?
GY Modifier: This modifier is used to obtain a denial on a non-covered service. Use this modifier to notify Medicare that you know this service is excluded.
Is CPT 90471 an add on code?
Immunization Administration Add-ons The immunization administration codes 90460-90461, 90471-90474 or G0008-G0010 are reported in addition to the vaccine or toxoid code(s) 90476-90756, Q2034-Q2039. When giving more than one vaccine/toxoid, multiple administration codes are reported.