News Flash

Important Policy Updates Regarding H1N1 - New Information

CareFirst BlueCross BlueShield (CareFirst) and CareFirst BlueChoice, Inc. (CareFirst BlueChoice) understand the importance of protecting members from the growing threat of the H1N1 influenza virus. To follow is our policy regarding the administration of the H1N1 flu vaccine.

How to obtain the vaccine

Providers can now pre-register online to administer the H1N1 influenza vaccine. Please visit your state's or jurisdiction's health department Web site for information on pre-registration. Below are links to health department Web sites for MD, DC and VA:

District of Columbia
http://newsroom.dc.gov/show.aspx/agency/doh/section/2/release/17978

Maryland
http://dhmh.maryland.gov/swineflu/h1n1registration.html

Virginia
http://www.vdh.state.va.us/epidemiology/immunization/h1n1prereg.htm

Benefits

Benefits will be provided according to members' contract type:

Fully insured

• For contracts that contain vaccine benefits, CareFirst and CareFirst BlueChoice will cover the cost to administer the H1N1 vaccine as per the benefit contract, and waive:
  a - Any contractual penalties for obtaining services from out-of-network providers, and
  b - Any referral and authorization requirements
• For the small number of contracts that do not offer vaccine benefits, vaccine administration will be reimbursed at 100% of the allowed amount.

Self Insured

• For non-risk accounts that have requested coverage for this vaccine, CareFirst and CareFirst BlueChoice will cover the administration of the H1N1 vaccine as per the benefit contract for all other vaccines.
• For accounts that have requested that the vaccine NOT be covered, members will receive no benefit coverage, and will be responsible for the cost to administer the vaccine only. The cost of the vaccine itself will be provided by the Federal government.

Billing

Effective immediately, the American Medical Association (AMA) has announced the following CPT codes for claim submissions:

• 90470 - H1N1 immunization administration (intramuscular, intranasal), including counseling when performed
• 90663 - Influenza virus vaccine, pandemic formulation H1N1.

The vaccine cost will be paid by the government; therefore CareFirst and CareFirst BlueChoice do not expect to receive a bill for the vaccine. If CareFirst and/or CareFirst BlueChoice receive a bill for the vaccine, it will be rejected with $0 member liability.

H1N1 Vaccination Billing Guidelines

When billing for the administration of the H1N1 vaccine (CPT 90470) please be sure to bill the appropriate ICD9 diagnosis code. Instead of billing 488.1 which is the diagnosis that would be billed if the patient actually has the H1N1 influenza you should bill the appropriate ICD9 ‘V’ code (i.e. V0481). This will allow us to process your claims more accurately and timely.

Please Note: Providers should not bill G codes to report H1N1 services.