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Medicare will cover vaccines for seasonal, pandemic flu viruses.

Medicare will cover both the seasonal influenza vaccine and a vaccine against pandemic influenza A(H1N1) virus, once one becomes available.

The Food and Drug Administration has cleared four of the five US. licensed manufacturers of seasonal influenza to make pandemic influenza A(HlNl) vaccine, and the first 3.4 million doses are expected to be available this month.

In a notice to physicians and other health care providers, officials at the Centers for Medicare and Medicaid Services said that the same billing rules will apply to the pandemic HlNl vaccine and the seasonal vaccine. However, because the pandemic HlNl vaccine will be provided at no cost by the government, Medicare will pay providers only for its administration.

CMS has issued two new billing codes to address HlNl vaccine this season. Providers can use G9141 for pandemic influenza A(HlNl) immunization administration, including physician counseling of the patient and family. Payment for G9141 will be the same as that for the administration of the seasonal influenza vaccine. CMS also has created a billing code, G9142, for the pandemic influenza A(H1N1) vaccine itself. However, that code will not trigger payment. Neither will Medicare pay for an office visit when its sole purpose is administration of either seasonal influenza vaccine or pandemic HlNl vaccine.

CMS has notified its carriers to prepare for early claims for the seasonal influenza vaccine. "We understand that such preparations are critical for the upcoming flu season, especially in planning for the influenza [A(HIN1)] vaccine," CMS wrote online.

Private insurers are also planning to extend coverage to the pandemic HlNl vaccine. Susan Pisano, a spokeswoman for America's Health Insurance Plans, the leading insurance industry trade group, said that if an insurer typically covers seasonal influenza vaccine, it will probably cover the pandemic HlNl vaccination in the same way. As CMS has announced for Medicare, private plans will not reimburse providers for the cost of the pandemic HlNl vaccine, as it is being provided by the government.

Ms. Pisano noted that the situation is fluid, and that her organization is meeting continually with public health officials to prepare for the flu season.
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Author:Schneider, Mary Ellen
Publication:OB GYN News
Date:Oct 1, 2009
Previous Article:FDA approves pandemic influenza vaccine: both nasal spray--delivered and injectable vaccine will be available and shipped around the country.
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