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Coding and Reimbursement Guidelines

Comprehensive information for adherence to federal regulations

Chart: Coding and Reimbursement Guidelines: Comprehensive information for adherence to federal regulations

a CPT (Current Procedural Terminology) is a registered trademark of the American Medical Association.

b NDC = National Drug Code. New Food and Drug Administration regulations require the use of different NDCs on the carton and unit-of-use.

c When influenza vaccine is given to a high-risk patient, consider a secondary ICD-9 code describing the high-risk condition.

d The Centers for Medicare and Medicaid Services (CMS) requests the use of V06.6 as the diagnosis when a Medicare beneficiary received influenza and pneumococcal vaccines at the same visit. Bill V06.6 with the CPT codes for both products and their administration. If only influenza vaccines is administered, use V04.81 for the product and its administration.

Administration coding:

  • Patient 18 years of age and under, with counseling provided - bill 1 unit of CPT 90460, signaling the use of a single-component vaccine.
    • - Note: Although influenza vaccines contain 3-4 strains of influenza, it protects against only 1 disease, making it a single-component vaccine.
  • Patient 18 years of age and under without counseling, or a patient 19 years of age and older regardless of counseling - bill 1 unit of CPT 90471 or 90472.
    • - Use 90471 if it is the first vaccine administered at that visit, or 90472 if it is a second or additional vaccine administered at that visit.
  • All Medicare patients for all influenza vaccines, bill 1 unit of G0008, regardless of age or counseling. Any other administration codes billed to Medicare will be denied.
  • Visit the "Reimbursement" page on VaccineShoppe.com for additional coding resources for Sanofi Pasteur products. Log on today and go to the "Reimbursement" tab.

Do you have questions on coverage or payment for Sanofi Pasteur products? Contact the Sanofi Pasteur Reimbursement Support Service (RSS). Call 1-800-VACCINE (1-800-822-2463) 1-800-VACCINE (1-800-822-2463) and choose the prompt for the RSS.

Chart: Coding and Reimbursement Guidelines: Comprehensive information for adherence to federal regulations

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