Vaccine Coding Table

Vaccine pending FDA approval [http://www.ama-assn.org/ama/pub/category/10902.html]

‡Effective 9/28/09, the AMA has released a new code specific to H1N1 immunization administration and revised existing code 90663 to include the H1N1 vaccine, which will streamline reporting and the reimbursement procedures for physicians and health care providers who are expected to administer nearly 200 million doses of the H1N1 vaccine in the United States. The codes will also help to efficiently report and track immunization and counseling services related to the H1N1 vaccine throughout the health care system. The codes are as follows:

• 90470 H1N1 immunization administration (intramuscular, intranasal), including counseling when performed

• 90663 Influenza virus vaccine, pandemic formulation, H1N1

To seek payment from payers following administration of 2009 H1N1 influenza type A monovalent vaccine, providers should bill CPT code 90663 (Influenza virus vaccine, pandemic formulation, H1N1) in conjunction with the immunization administration code 90470 (H1N1 immunization administration (intramuscular, intranasal), including counseling when performed). The 90663 code for the 2009 H1N1 vaccine itself should be billed for zero dollars, since the vaccine is provided free of charge by the federal government. Providers will be paid for 2009 H1N1 vaccine administration.

To meet the needs of the Centers for Disease Control and Prevention (CDC) safety monitoring programs, the AMA suggests listing the National Drug Code (NDC) assigned by the US Food & Drug Administration (http://www.accessdata.fda.gov/scripts/cder/ndc/default.cfm) on the claim form (line 24) in addition to code 90663 (see National Uniform Claim Committee NUCC™ 1500 Claim Form Instruction Manual, pgs. 43-45 http://www.nucc.org/images/stories/PDF/claim_form_manual_v5-0_7-09.pdf).

Developed and maintained by the American Academy of Pediatrics. For reporting purposes only.