It is expected that seasonal influenza and other respiratory viruses will be co-circulating alongside COVID-19 this fall and winter. As such, we have successfully advocated for reactivating the temporary respiratory immunization fee codes for influenza, pneumococcal, and pertussis immunization in pregnancy.
The information below outlines how to bill for respiratory immunizations in your clinic for both children and adults. (Billing for immunizations in children has not changed.)
Adults who are eligible for publicly funded immunizations
OPTION 1: Bill fee code 10040 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 pertussis immunization in pregnancy with ICD9 V036) The second 10040 claim must be submitted with submission code D or it will be refused.
OPTION 2: Bill fee code 10041 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.
Children who are eligible for a flu shot or nasal spray
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.
More information about billing for immunization
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.