SCENARIO: Billing for Influenza and Pneumococcal Vaccines

If influenza vaccine and pneumococcal vaccine are administered at the same encounter, can an administration fee be billed for each vaccine?

The Centers for Medicare and Medicaid Services address this question in its guide on Medicare Part B Immunization Billing.

When a beneficiary gets both the seasonal influenza virus and pneumococcal vaccines on the same visit, do I continue to report separate administration codes for each type of vaccine?

Yes, see https://www.cms.gov/Medicare/Coverage/CoverageGenInfo/ICD10.html for individual Change Requests (CRs) and coding translations for ICD-10. 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.

1/11/16Pneumococcal vaccine administeredG00091Z23

Date Type CPT Code Units Diagnosis Code
1/11/16 Influenza vacccine G0008 1 Z23

If the vaccines were administered to a patient having commercial insurance the CPT codes for vaccine administration would apply. CPT90471 would be used in association with the first vaccine administered and CPT90472 would apply to the second vaccine administered.

1/11/16Pneumococcal vaccine administered904721Z23

Date Type CPT Code Units Diagnosis Code
1/11/16 Influenza vacccine 90471 1 Z23

Medicare Advantage plans may choose to use either the G codes noted in the first example or the CPT codes noted in the second example. Information may be on the plan website that will direct you regarding the plan’s coding preference.