| Payer |
Coverage |
Codes |
| Aetna |
Administration coverage only.
|
Admin: (age appropriate CPT Codes 90465-90474).
Vaccine: 90663
|
Blue Cross
Blue Shield of Mass. |
Administration coverage for plans that include
preventive services. |
Admin: (age appropriate CPT codes 90465-90474).
Vaccine: 90663
|
| CIGNA |
Administration
coverage for plans that include preventive services. |
Admin: (age appropriate CPT Codes 90465-90474).
Vaccine: 90663
|
| Fallon |
Administration
coverage only. |
Admin: (age appropriate CPT Codes 90465-90474).
Vaccine: 90663 with SL modifier
|
| Health New
England |
Administration
coverage only. |
HNE is in process of
determining coding requirements. |
| Harvard Pilgrim |
Admin. coverage of
H1N1 vaccine (2 doses). |
Admin: (age appropriate CPT Codes 90465-90474).
Vaccine: 90663 with SL modifier
|
| MassHealth |
Administration will be reimbursed, but only if the primary
purpose of the visit is for immunization. If immunization is not the
primary purpose of the office visit, the physician may bill for the
office visit, but not for the administration of the vaccine. |
| Medicare |
Medicare will pay for the
administration of the H1N1 vaccine.
Medicare will not reimburse for office
visit codes when the only purpose of the visit is to administer either
the H1N1 or seasonal flu vaccine. Read
the CMS memo on coverage. (.pdf)
|
Code G9141 - Influenza A (H1N1) immunization administration (includes
the physician counseling the patient/family)
|
| Network Health |
Administration
coverage only. |
Admin: (age appropriate CPT Codes 90465-90474).
Vaccine: 90663
|
| Tufts Health
Plan |
Administration coverage only. |
Admin: (age
appropriate CPT Codes 90465-90474).
Vaccine: 90663 with SL modifier
|
| Neighborhood Health
Plan |
Administration
coverage only. |
Admin: (age
appropriate CPT Codes 90465-90474).
Vaccine: 90663 with SL modifier
|
| United Health
Plan |
Administration
coverage only. |
To ensure proper
claims processing, please include allowable charge for 90663 and G9142
of $0.01. |
| Note: The H1N1 vaccine and associated supplies will be
provided by the federal government to health care providers free of
charge. None of the above health plans are paying claims for the
cost of such materials. |
| Read
a Q&A from the CDC on vaccine administraton billing. |
