H1N1 vaccine: Important administration and reimbursement information

Flu season is upon us and working to prevent and contain the spread of the H1N1 virus is an important priority at Regence. Because the federal government is making vaccine available at no cost, we will reimburse for the administration of the H1N1 vaccine for our members (except Boeing). See the paragraph below related to H1N1 coverage for Boeing employees.

To remove financial barriers associated with administration of the H1N1 vaccine, and to encourage members to seek vaccination, for a limited time, we are:

• Providing coverage for the costs associated with the administration of the H1N1 vaccine
• Waiving copayments, deductibles and coinsurance for all of our members

Regence will reimburse administration of the H1N1 vaccine at the following rates:

• Participating physicians, other health care professionals and facilities:
• $20.43 or billed charges, whichever is less according to Medicare reimbursement for Locality 99, for all Regence members, except those on Healthy Options.
• The Medicaid rate for Healthy Options members

To ensure accurate payment for administration of the H1N1 vaccine, participating and non-participating physicians, health care professionals and facilities should use the following guidelines:

• Use HCPCS G9141 or CPT 90470 for the administration of the H1N1 vaccine
• Use ICD-9-CM V04.81 as the diagnosis code
• Facilities should use revenue code 0771

Visits associated with administration of the H1N1 vaccine

• Payment will not be made for an office visit if the sole purpose of the visit is to administer the H1N1 vaccine
• For facilities, payment will not be made for revenue codes 045X, 051X, 096X and 098X and an evaluation and management CPT code for the sole purpose of a visit to administer the H1N1 vaccine

Seasonal flu vaccine
Regence will continue coverage of seasonal flu vaccine administration for those whose health plan benefits offer vaccine coverage. No pre-authorization is required. Contact Customer Service to determine member benefits for the seasonal flu vaccine.

For questions, please contact your provider consultant.

H1N1 coverage for Boeing employees

Boeing will cover H1N1 immunizations according to the member’s preventive benefit. With the exception of the Traditional Medical Plan (TMP) for IAM 751, most Boeing plans cover immunizations as part of the preventive care benefit.

To ensure accurate payment for the administration of H1N1 vaccine to a Boeing member, we encourage you to check the member’s benefit to ensure the service is covered. You may do this by calling Boeing Customer Service at 1-800-422-7713.

A summary of the various preventive care benefits for Boeing nonunion, SPEEA and IAM 751 populations is provided below:

10/26/2009