February 7, 2017

Influenza Virus Vaccine HCPCS Codes

CGS has seen that some providers are incorrectly reporting HCPCS code 90471 for the administration of the influenza vaccine. Instead, providers should submit G0008. HCPCS code 90471 is for outpatient prospective payment system (OPPS) hospitals billing the hepatitis B vaccine administration. When 90471 is reported by home health and hospice providers, the Fiscal Intermediary Standard System (FISS) applies coinsurance and deductible.

If you have submitted HCPCS 90471 for the administration of the influenza flu vaccine on home health claims (341 type of bill) or hospice claims (81X or 82X type of bill), you will need to submit an adjustment to change the HCPCS code to G0008 in order to remove the coinsurance and deductible amounts.

Please refer to the Medicare Claims Processing Manual (Pub 100-04) Chapter 18, Section 10.2.1External PDF for a complete list of HCPCS codes for billing of pneumococcal pneumonia, influenza virus, and hepatitis B vaccines and their administration.

Two Vantage Way, Nashville, TN 37228 © CGS Administrators, LLC. All Rights Reserved