Providers with billing questions

Washington State Medicaid’s billing instructions call for providers to use G9142 for administration of the H1N1 vaccine.  This is consistent with Medicaid’s existing policy for vaccines that are provided free of charge from Department of Health. But some Medicaid providers have been confused by Medicare’s instruction to use G9141 for the administration of H1N1 vaccine. Washington providers should continue to bill Medicaid with the G9142 code. For more information, providers should call the Medical Assistance Customer Service Center at 1-800-562-3022.  

Medicaid reimbursement for administering the H1N1 vaccine will be $12.94 for either the nasal spray or inoculation versions of the vaccine, according to Dr. Jeffery Thompson, the Chief Medical Officer for the Medicaid program. The rate applies to administering the vaccine, while the vaccine itself is being provided without charge by the Department of Health.

The Department of Health said it expects the first 71,000 doses of H1N1 vaccine will be arriving in the state over the next few days, and local health jurisdictions will be responsible for distributing it on to providers. Those initial doses will be in the nasal spray form. Vaccine that can be administered as a shot will be arriving later.

Dr. Thompson said high-risk groups will be the first priority for vaccination until health officials are satisfied that there is enough vaccine for less-threatened populations. Those high-risk, first-priority vaccine targets include:

• Pregnant women
• Children and young people, six months through 24 years
• People younger than 64 who have conditions such as asthma or diabetes that increase the risk of complications from flu
• Health workers and caregivers of newborns.

The flu mist spray is not recommended for pregnant women or people with chronic illnesses. Dr. Thompson said it is aimed primarily at health workers, babies' caregivers and healthy young people.

Dr. Thompson said seasonal flu is more threatening for the elderly, but that the H1N1 virus appears to strike harder at younger ages. He said most adults will need only a single dose of the H1N1 vaccine, just like the regular seasonal vaccine. Children under 10 may need two doses, spaced several weeks apart.

FOR ADDITIONAL BACKGROUND, CONTACT:

Jim Stevenson, Communications Director, HRSA, DSHS, 360-725-1915 (Pager: 360-971-4067).