As family doctors continue to provide critical frontline care during the ongoing pandemic, we have been advocating for funding to assist you with providing care in the changing pandemic conditions. We have been successful in reactivating last year’s temporary fee codes for influenza and pneumococcal immunizations in adults to address the increased costs of providing immunizations during COVID-19.
In addition, we recommended and were successful in having pertussis immunization in pregnancy added to the list of immunizations for which these fee codes can be billed. This has been a publicly funded vaccination in BC since November 2020. Pertussis vaccine (usually provided as Tdap) can be offered to pregnant women/people at no charge for protection of the infant against whooping cough infection.
Both the temporary respiratory immunization fee codes are effective for dates of service on or after October 1, 2021. The end date is April 30, 2022.
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 PUBLICLY FUNDED IMMUNIZATIONS
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 two immunizations, you can bill 10040 x 2 services along with the visit. For example, if you provide both an influenza and a pertussis immunization in pregnancy, you can bill 10040 x 2 (one for influenza with ICD9 V048 and one for perussis immunization in pregnancy with ICD9 V036) 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), Pneumococcal (using ICD-9 code V05) and Pertussis during pregnancy (using ICD-9 code V036) 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 and/or V036 for Pertussis during pregnancy.
OPTION 2: Bill fee code 10041 (using ICD-9 code V048) when the primary purpose of the service is for immunization.
If you provide two immunizations, you can bill 10041 x 2 services. For example, 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), Pneumococcal (using ICD-9 code V05) and Pertussis during pregnancy (using ICD-9 code V036) 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 for influenza
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