UPDATE for H1N1 vaccine administration claim submission
DSHS will provide the H1N1 flu vaccine free of charge to registered providers. Information about registration with DSHS to receive the H1N1 vaccine is available on the agency’s website at www.dshs.state.tx.us/txflu/flu-vaccineprovider.shtm.
Texas Medicaid reimburses for administration of the intranasal or injected H1N1 vaccine. Medicaid will reimburse the administration fee for up to two doses per client, any provider, when the doses are given on different dates following the Advisory Committee on Immunization Practices (ACIP) guidelines. (See www.cdc.gov//flu/professionals)
In order to be reimbursed for the administration of the H1N1 flu vaccine, providers must submit a claim for the administration of the vaccine in one of the following ways:
· To submit vaccine administration procedure code 90465, 90466, 90471, or 90472, providers must include on the claim the H1N1 pandemic flu vaccine procedure code 90663, which will process as informational only.
· To submit vaccine administration procedure code 90470, which is specific to the administration of the H1N1 vaccine, providers do not need to include the procedure code for the vaccine.
Note: Claims will be processed faster when submitted with procedure code 90663 along with an appropriate administration code. Because of system constraints, claims submitted for procedure code 90470 may initially be denied with EOB 1086, “A valid vaccine procedure code is required on the same claim with an administration procedure code.” Claims that are denied with EOB 1086 on a Remittance & Status (R&S) report will be reprocessed the following week, and payments will be adjusted accordingly. No action on the part of providers is necessary.
Providers must use only one method to bill for the administration of the vaccine. Either method has the same reimbursement rate.
Administration of the H1N1 flu vaccine will be reimbursed separately from a THSteps visit or office visit.
For Medicaid Managed Care, H1N1 claims for vaccines provided in a provider’s office will be submitted to the appropriate HMO.
For more information, call the TMHP Contact Center at 1-800-925-9126.