You can now submit your 10041 billings for adult respiratory immunizations done without a visit for an unrelated reason. If you already billed under fee code 00010 for influenza or pneumococcal immunization in adults since October 1, you can debit the 00010 ($11.37) and resubmit 10041 ($14.00).
Eligibility
Influenza immunizations are recommended and provided for free to:
- People at high risk
- People capable of transmitting influenza to those at high risk
- People who provide essential community services
The full eligibility list is noted in this document from the BCCDC.
Billing
We have been advocating since the summer for appropriate remuneration for flu shots to address the increased costs of providing immunizations due to COVID-19. We have been successful in securing two new temporary fee codes for influenza and pneumococcal immunizations in adults.
Both are effective for dates of service on October 1 or later. The end date is April 30, 2021.
Billing for immunizations in children has not changed. We have provided the information below to assist you with billing both in your clinic and at mass immunization clinics in other locations.
Immunizations done in your office
ADULTS WHO ARE ELIGIBLE FOR A FREE FLU SHOT
OPTION 1: Bill fee code 10040 (using ICD-9 code V048) plus the age-appropriate visit service when the immunization is done with an in-person visit for an unrelated reason (office visit, prenatal visit, counselling, consultation etc).
If you provide both an influenza and a pneumococcal immunization, you can bill 10040 x 2 services (one for influenza with ICD9 V048 and one for pneumococcal with ICD9 V05) along with the office visit. The second 10040 claim must be submitted with submission code D or it will be refused.
10040 Respiratory immunization for patients 19 years of age or older (with visit) …………….. 5.43
Notes:
- Payable for Influenza (using ICD-9 code V048) and Pneumococcal (using ICD-9 code V05) immunizations.
- Payable in full with an office visit.
- If the primary purpose of the visit service is for immunization, bill fee item 10041 using ICD-9 code V048 for influenza and/or V05 for pneumococcal.
OPTION 2: Bill fee code 10041 (using ICD-9 code V048) when the primary purpose of the service is for influenza immunization.
If you provide both an influenza and a pneumococcal immunization, you can bill 10041 x 2 services (one for influenza with ICD9 V048 and one for pneumococcal with ICD9 V05). The second 10041 claim must be submitted with submission code D or it will be refused.
10041 Respiratory immunization for patients 19 years of age or older (without visit) ………………….. 14.00
Notes:
- Payable for Influenza (using ICD-9 code V048) and Pneumococcal (using ICD-9 code V05) immunizations when the primary purpose of the service is for immunization.
- Not payable with an office visit.
CHILDREN WHO ARE ELIGIBLE FOR A FREE FLU SHOT (OR FLUMIST)
Bill under fee item 10015 (using ICD-9 code V048) plus the applicable office visit (00100 or 12100) for children under 19 years of age. In the pediatric population, immunizations are billable in addition to a visit.
10015 Influenza (Flu)…………………………………………………………….5.43
Immunizations for Patients 18 Years of Age or Younger
Notes:
- For immunizations of patients age 19 or older, use fee item B00010, B00034.
- Not payable for immunizations required for travel, employment and emigration.
- Payable per injection.
- Payable in full with an office visit to a maximum of 4 injections per patient per day.
- Not payable on the same day with B00010, B00034.
Mass immunization clinics
ADULTS WHO ARE ELIGIBLE FOR A FREE FLU SHOT
Bill fee code 10041 (using ICD-9 code V048) when the primary purpose of the service is for influenza immunization.
If you provide both an influenza and a pneumococcal immunization, you can bill 10041 x 2 services (one for influenza with ICD9 V048 and one for pneumococcal with ICD9 V05). The second 10041 claim must be submitted with submission code D or it will be refused.
10041 Respiratory immunization for patients 19 years of age or older (without visit) ………………… 14.00
Notes:
- Payable for Influenza (using ICD-9 code V048) and Pneumococcal (using ICD-9 code V05) immunizations when the primary purpose of the service is for immunization.
- Not payable with an office visit.
CHILDREN WHO ARE ELIGIBLE FOR A FREE FLU SHOT (OR FLUMIST)
Bill under fee item 10015 (using ICD-9 code V048) plus the applicable office visit (00100 or 12100) for children under 19 years of age. In the pediatric population, immunizations are billable in addition to a visit.
The mass immunization clinic location serves as your “office” for the time period in which you are giving flu shots as you will be seeing multiple patients. The out-of-office visit fee codes should not be used.
10015 Influenza (Flu)……………………………………………………………5.43
Immunizations for Patients 18 Years of Age or Younger
Notes:
- For immunizations of patients age 19 or older, use fee item B00010, B00034.
- Not payable for immunizations required for travel, employment and emigration.
- Payable per injection.
- Payable in full with an office visit to a maximum of 4 injections per patient per day.
- Not payable on the same day with B00010, B00034.
More information about billing for immunizations
If you have further questions about billing for influenza or other immunizations, you can send us a billing question.
Information on billing for all immunizations can be found in our Simplified Fee Guide.
Photo credits: Heather Hazzan, SELF Magazine, Michael Browning on Unsplash, and Josh Applegate on Unsplash