Resources - H1N1 Vaccination and Disease Tracking
Current CDC Resources Links
Provider Reimbursement/Patient Charges/Diagnosis/Insurance Info
- 90470 - H1N1 immunization administration (intramuscular, intranasal), including counseling when performed (effective 9/28/09)
- 90663 — Now includes Influenza virus vaccine, pandemic formulation and H1N1 (effective 9/28/09)
- 488.1 - ICD-9-CM code for H1N1 (effective 10/1/09)
- G9141 - Medicare code for vaccination administration
- G9142 - Medicare code for H1N1 vaccine
More details at http://www.cdc.gov/H1N1flu/vaccination/statelocal/vaccine_financing.htm
H1N1 Vaccination Registration and Planning Information - moved to bottom of page
Provider Pre-Registration Sites by State
Following is a list of currently available pre-registration programs for participating in the national H1N1 vaccination campaign. Updated 11/2/09. The CDC has a listing now as well on their website.
H1N1 Vaccination Preparation Information Summary - (most recently updated information in bold italics)
UCAOA is working with the CDC’s H1N1 Vaccination Implementation Team to keep providers informed about the CDC’s plans for H1N1 vaccinations this Fall (2009). The following information is the latest we are aware of as of September 18, 2009. All information on this page has been provided by the CDC but is summarized by UCAOA.
Patients can be directed to the CDC's Q&A site for the public here.
Vaccination Program and Supply
The CDC is putting plans in place for a nationwide vaccination campaign. As part of this campaign, participating providers will be given vaccination supplies at no cost (the federal government will be purchasing the vaccine and shipping to participating providers). To date, about 10,000 provider sites have signed up to participate. The supplies will include the vaccine, syringes, needles, sharps containers and alcohol swabs. A request has been made to get the exact models of the supplies so staff can be trained on using them as needed. The needles will be 1 inch needles.
The projections for US novel H1N1 vaccine supply are for 45 million doses available in early-October followed by weekly amounts of 20 million doses. 30% of the 45 million will be formulated for children and pregnant women. Clinical trials to date are indicating only one dose will be needed for children 10 and up and adults, two doses for children under 10, but this is not final.
Clinics who participate in the program will have a minimum order size of 100 doses (all lots are in 100's). Distribution plans and provider agreements for participation are still in development. They are measuring the "footprint" of a 100-dose box so clinics can prepare for storage. There can be a mix of formulations (single-dose, multi-dose, spray) in orders.
Vaccination shipments will also contain a vaccination record card for the patient to keep.
The provider agreements have been released to state health departments as of 8/28. This does not mean that all states are ready to distribute agreements. Each site that will be receiving a vaccine shipment needs to have a separate agreement. Be advised - part of participation in this program may include some basic weekly reporting requirements that will be dictated by your state. This reporting may include the vaccinator site, patient name, lot #, manufacturer, date given, and return date for subsequent dose. However, there is not a requirement to enroll in the Vaccine for Children (VFC) program to participate (this is a myth). The CDC is strongly recommending that health departments carefully consider requiring reporting from new and one-time providers. See our list by state of who has registration ready now.
Reimbursement to Providers and Charging Patients/Billing Insurance
Participating providers will be able to charge/bill for ADMINISTRATION of the vaccine, but not the supplies (as they were free to you). THERE WILL NOT BE a special CPT code has been established for the billing of that administration. The CDC was working with insurance industry representatives to establish a national standard reimbursement, but were not able to secure that.
As part of the Provider Agreement, providers cannot CHARGE patients (as in cash) more than the Medicare cap rate for regular flu vaccine (except Medicaid patients). Providers can BILL insurance companies for more than that rate if your current contracts allow. It is likely you will bill the administration fee for H1N1 exactly as you bill the administration fee for seasonal flu vaccine. Check with your payer contracts to be sure. Providers with patients unable to pay may either give the vaccine for free, or refer the patient to the local health department - but remember that if you are not charging some patients you cannot then bill MEDICARE for a fee for another patient - you must be consistent. Public health facilities are allowed to bill insurance for an administration fee - they cannot charge a patient an administration fee.
Many issues have been brought up regarding reimbursement and specific insurance groups (HMO's) that may typically require vaccine administration by primary care physicians only to receive reimbursement. The CDC is working on these. There will be a financial Q&A issued soon.
Health plans are being encouraged by the CDC to look at their benefits plans and provider agreements to ensure coverage for the vaccine.
Participation Process
The Provider Agreement has been made available to all states. The CDC now has its own website with state listings.
There has been some confusion about who should sign the Provider Agreement - it needs only to be one person from the site that can legally bind the clinic - NOT ALL THE PROVIDERS. The CDC also recommends that centers look at their staffing models for the upcoming flu season and consider the possibility of concurrent illness and vaccination activities - these are likely to have considerable impact on the numbers of patients entering clinics.
Vaccine Administration
While clinical trials are currently underway to confirm the final process, it is likely that the vaccine administration will be as follows:
- Novel H1N1 vaccine will likely require 2 doses - at least for some segments of the population -Clinical trials to date are indicating only one dose will be needed for children 10 and up and adults, two doses for children under 10, but this is not final.
- H1N1 vaccine dose 1 can be able to be administered at the same time as seasonal flu vaccine - however, if using "mist" versions of both vaccines, immunigenity may be compromized (though there is no known harm) so a combination of delivery methods is recommended, or separate vaccinations by 4 weeks
- H1N1 vaccine dose 2 will be administered 21-28 days following the first dose
- Additional clinical guidelines on special circumstances is on the CDC website
The Advisory Committee on Immunization Practices (ACIP) has identified the following 5 priority groups:
- Pregnant women
- Household contacts/caregivers of children less than 6 mos. old
- Healthcare and emergency services personnel (includes medical workers, not firefighters or law enforcement, etc. Does not include those administering vaccine - only those likely to be treating the ill - which may be one and the same in urgent care, however)
- All persons 6 months to 24 years old
- Adults 25-64 years old with health conditions associated with higher risk
- The phasing of vaccinating these priority groups will be determined by each state
- The CDC is working on "messaging" to help providers counsel individuals not in a priority group who still want to be vaccinated in the early phases
Additional recommendations:
- Providers should not "reserve" 2nd doses of vaccine. There should be enough supply for 2nd doses to be available by the time the patient returns.
- Providers should not delay seasonal flu vaccine administration for H1N1 vaccine to
arrive
- Social isolation information is available for you to share with patients. Schools especially are being encouraged to relax their attendance requirements in case of an outbreak.
- The CDC is not currently aware of a risk of Guillaine-Barre Syndrome with this vaccine, it is not expected.
- Please do not set up any INDEPENDENT arrangements with schools for a vaccination program. ONLY do that through your public health agencies.
