Public Health Policy

How to Get Paid for Administering H1N1 Vaccine and Additional Information

Brief Summaries on the following are below:

• Billing for H1N1 Vaccine from the AAFP, Medicare and MaineCare, links provided
• Availability for health care provider to register to receive H1N1 Vaccine
• Anticipated first large shipments due to arrive in mid-October
• New H1N1 School-Located Vaccine (SLV) Clinic information
• Updated Interim Recommendations (9-18-09) for H1N1 Treatment of Pregnant Women can be found at: http://www.cdc.gov/H1N1flu/pregnancy/antiviral_messages.htm
• H1N1 Residential School and H1N1 Vaccine Availability
• Two Email Addresses for H1N1 Questions and Reporting
• Keep Informed!

http://www.aafp.org/online/en/home/publications/news/news-now/practice-management/20090916h1n1-paymt.html

Medicare Billing Info for H1N1 Vaccine
http://www.cms.hhs.gov/MLNMattersArticles/downloads/se0920.pdf

MaineCare Roster Billing for H1N1 and Seasonal Vaccine for Schools (similar info for home health agencies forthcoming)
http://www.maine.gov/dhhs/oms/providerfiles/billing_instructions.html

The FDA's approval of four vaccines against the novel influenza A (H1N1) virus is official. Now, physicians in private practice need details from health insurance companies about how to code and bill payers for administering the vaccine to receive timely payment for this service.

CMS has created a unique health care common procedure coding system, or HCPCS, code -- G9141 -- specifically to cover administration of the H1N1 vaccine, although private insurers are not required to use the G code.

The AAFP has confirmed the following instructions from the country's largest private health insurers and Medicare.

• UnitedHealthcare is asking physicians to submit the CPT vaccine administration code appropriate to patient age, route of administration and number of vaccines administered. In addition, physicians must submit CPT code 90663 for the vaccine itself and indicate an amount of $0.01. The federal government is providing the vaccine free of charge, but some claims clearinghouse systems will reject CPT codes with a $0 charge.
  
• CIGNA is asking physicians to bill for the administration of H1N1 flu vaccines using the new G9141 HCPCS code.
  
• Aetna wants physicians to use age-appropriate CPT codes -- 90465-90468 for children or 90471-90474 for adults. Use of the G9141 HCPCS code also is permissible.
  
• Humana prefers that physicians use the HCPCS G9141 code when filing a claim for administration of the H1N1 vaccine.
  
• Because of the large number of Blue Cross Blue Shield companies, the AAFP cannot give definitive instructions for these payers. If physicians have questions about H1N1 vaccine administration payment, they should contact their local BCBS plan.
  
• WellPoint and Wellpoint's subsidiary, Anthem, have not released instructions to physicians regarding administration of the H1N1 vaccine.
  
• Medicare wants physicians to bill for administration of the H1N1 vaccine using the HCPCS G9141 code. Payment will be the same as for administration of the seasonal influenza vaccine. More information about CMS' H1N1 vaccine payments is available in a recent MLN Matters.
• Availability for health care provider to register to receive H1N1 Vaccine
• (Go to http://www.maine.gov/tools/whatsnew/attach.php?id=79438&an=2 for more information)

This health alert is to update health care providers on the availability of the ability to order H1N1 vaccine. As you may know, pregnant women, children and young adults are being disproportionately affected by novel H1N1 influenza virus (“swine flu”). We expect to start receiving H1N1 vaccine in Maine by mid-October. If you are a health care provider licensed to administer vaccine, we ask that you consider registering to receive the H1N1 vaccine.

SCHOOL-LOCATED VACCINE CLINICS
We also encourage you to become involved with the initiative to offer all children seasonal and H1N1 vaccines in Maine schools. This will assure all Maine children are offered vaccine as quickly and as efficiently as possible while also not overburdening the health care system. If you are interested in becoming involved, please contact your local schools, or call the Maine CDC at 1-888-257-0990, or check the school-located vaccine website at www.maineflu.gov. Thank you ahead of time for your consideration in this important public health effort to keep our communities and schools healthy!

REGISTRATION TO RECEIVE H1N1 VACCINE
Even if you already receive vaccine from Maine CDC, you need to register separately to receive H1N1 vaccine.

To register, fill out and submit the H1N1 Provider Agreement for H1N1 Vaccine, which can be found at: http://www.maine.gov/dhhs/boh/maineflu/h1n1/provider-agreement-2009-2010.shtml

For questions regarding H1N1 influenza vaccine ordering see the FAQ in this document. For other questions:

• Contact the Maine CDC’s Immunization Program at 287-3746
• Email us questions at: flu.questions@maine.gov
• More info can be found at www.maineflu.gov
• Updated CDC guidance on H1N1 influenza vaccine including vaccine handling can be found at: http://www.cdc.gov/h1n1flu/vaccination

H1N1 vaccine will only be available through state health departments (Maine CDC/DHHS in Maine), and will not be available for private purchase from manufacturers.

Anyone interested in offering H1N1 vaccine must complete and submit the H1N1 Provider Agreement. Even those who are already registered Maine Immunization Program providers and who have already completed paperwork to offer seasonal flu vaccine must submit this form.

There are two important requirements for the receiving end of H1N1 vaccine.

• The vaccine must be placed into a working refrigerator that is dedicated to storing vaccine and can maintain the vaccine’s temperature of 35.6 to 46.4 degrees Fahrenheit (2 to 8 degrees Celsius). The vaccine must NOT be exposed to freezing temperatures. A “dorm” style refrigerator in which the freezer and refrigerator share an exterior door is not appropriate. For further details on handling: http://www.cdc.gov/h1n1flu/vaccination.
• A physician or nurse practitioner with an active Maine license should be on record to be providing oversight for the vaccine.

Completing the H1N1 Provider Agreement is your way of demonstrating interest. Each state is given a limit of the number of distribution sites, so we ask that health care providers consolidate their registrations. For instance, we ask that outpatient practices with multiple health care providers submit one registration form.

Once the designated H1N1 Vaccine Providers are identified, we will take orders for H1N1 vaccine. The H1N1 Vaccine Order Form is currently being developed and will be posted on our web site as soon as it is available. In the mean time, we suggest that you start assessing how many doses you will need so that you are ready to place your order as soon as we have the ordering process in place.

New H1N1 School-Located Vaccine (SLV) Clinic Information

New H1N1 School-Located Vaccine (SLV) Clinic Information is available from the Maine CDC to provide information for planning and conducting school-located 2009 H1N1 influenza vaccination clinics that target school-aged children enrolled in school and potentially other groups in the community. SLV can be defined as vaccination that is:
Administered on school grounds
Targets enrolled students and potentially others
Held before, during and/or after school hours
Typically involves collaboration between public health departments and public and private schools/school districts

For more information, go to the links provided below:

Maine CDC Flu School Vaccine Clinics Website
http://www.maine.gov/dhhs/boh/maineflu/schools/index.shtml

School Located Vaccination Information for Planners
http://www.cdc.gov/h1n1flu/vaccination/slv/planners.htm

School Located Vaccine Template Forms
http://www.cdc.gov/h1n1flu/vaccination/slv/relatedmaterials.htm

Residential School and H1N1 Vaccine Availability

The school must register in order to receive H1N1 vaccine. Go to: http://www.maine.gov/tools/whatsnew/attach.php?id=79438&an=2 for information on how to register. The Maine CDC requests that if you are a residential school (college, university, boarding school, etc.) with the ability to vaccinate your students with a licensed health care provider, that you partner with a local health care provider, such as a hospital or health center to receive vaccine from them. If you have a large student body (over 1,000 students) with an onsite health facility with the ability to meet the vaccine handling requirements, then consider registering to receive the H1N1 vaccine. Maine CDC is limiting the number of vaccine distribution sites available in Maine, and want to make sure smaller schools start arranging for how they will receive vaccine, and larger schools register to receive it. If anyone needs assistance n connecting with resources (vaccinators, etc.) the names and contact information is found at www.maineflu.gov) or call the Maine CDC at 1-888-257-0990 to request assistance.

Reporting outbreaks in schools: Contact Maine CDC at 1-800-821-5821 or email: disease.reporting@maine.gov Infectious Disease Epidemiologists will respond and provide guidance on disease monitoring and control. Schools are also asked to report when they are considering closing due to illness. Epidemiologists will follow up on all reported outbreaks to provide guidance on the prevention and control of influenza and continued monitoring of students and staff for ILI (influenza Like Illness). School health officials and Maine CDC epidemiologists will establish communication to share information and resources to better understand the outbreak and how it can be controlled.

The collective common goal is to prevent the spread of influenza and to reduce severe illness and death due to influenza.

TWO EMAIL ADDRESSES FOR H1N1 QUESTIONS:

FLU.QUESTIONS@MAINE.GOV
In order to streamline communications, and to help us develop FAQs and other targeted communications, we have established an e-mail box called flu.questions@maine.gov.

This e-mail address is being posted for the public as well. To help us track questions, we ask that if you have a formal role with H1N1, that you identify that role, by for instance, submitting the source or target of the question in the subject line. For example: Phone Bank Question, VC Question, RRC Question, Field Epi Question, etc.

Tara Thomas will be monitoring this e-mail box, and will gather questions that need answering every morning at 9 am. If the question is forwarded, both the original questioner and the person forwarding the e-mail will be sent the reply.

DISEASE.REPORTING@MAINE.GOV
Medical and clinical questions related to influenza should be directed to disease.reporting@maine.gov. These inquiries are triaged throughout the day by the Epidemiologist On Call, and typically are sent to a Field Epidemiologist for response.

KEEP INFORMED

• Stay Updated:
  • Check the Maine CDC H1N1 Website: www.maineflu.gov
  • Check the Weekly H1N1 Updates: Check the Thursday updates on H1N1 in Maine on Maine’s H1N1 website: www.maineflu.gov. You can subscribe to these updates via their RSS feed.
  • Sign Up to Receive Health Advisories: Sign up to receive urgent updates from Maine CDC’s Health Alert Network (HAN). The easiest and quickest way is to sign up is through the HAN Alert RSS feed at www.mainepublichealth.gov (midway down the center of the homepage).