Important H1N1 Influenza Update
Confirmed cases of the H1N1 influenza have already been reported in the Commonwealth of Pennsylvania. Our combined efforts are needed to ensure our most vulnerable citizens are protected. As a part of those efforts, Gateway is encouraging all health care providers to pre-register for the H1N1 Influenza program recently announced by The Pennsylvania Department of Health (DOH). The program gives selected providers the opportunity to receive a supply of H1N1 vaccine along with items such as needles, syringes, sharps containers, and alcohol swabs free of charge. The supply is to be administered to persons who fall within the 5 targeted groups listed below:
- Pregnant women
- People who live with or care for children younger than 6 months of age
- Health care and emergency services personnel
- Persons 6 months to 24 years of age
- Adults under 65 years with medical conditions
In order to participate in the program, providers must pre-register online with the Pennsylvania Statewide Immunization Information System (PA-SIIS) at https://siis.health.state.pa.us/siis and select the H1N1 Online Pre-Registration Request. For questions or assistance about registration in the PA-SIIS please contact the PA-SIIS Help Desk at 1-877-774-4748; all other questions regarding H1N1 influenza vaccination pre-registration should be directed to Dr. John Bart at 717-787-4366.
Telephone Triage Script
Using telephonic triage of patients with a respiratory illness instead of having them come into the office is one way to reduce spreading the influenza virus. Figuring out what telephone triage protocol to use may be a challenge. We recommend reading the article, “Telephone Triage for Patients with Influenza” written by Jonathan L. Temte, MD, PhD from the University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin. In his article Dr. Temte offers primary care practices one successful approach to telephone triage for influenza.
This article is included with this issue of The Gateway Review.
Billing Procedures – Gateway Medicaid
Effective September 1, 2009 Gateway will reimburse providers $10.00 for the administration of the H1N1 vaccine. Gateway will not reimburse for the vaccine and supplies since they will be provided free of charge. Providers must bill using HCPC code G9141-(Influenza A (H1N1) immunization admin (includes physician counseling for the patient/family). For Gateway’s Medicaid plan the following codes are reimbursed for the seasonal flu vaccine regardless of whether you use your personal stock or obtain your flu vaccine supply from Vaccines for Children (VFC). The administration fee is included in the reimbursement for the vaccine.
- 90655-Influenza virus vaccine, split virus, preservation free, 6-35 months dosage, for intramuscular or jet injection use.
- 90656-Influenza virus vaccine, split virus, preservation free, 3 years and above, for intramuscular or jet injection use.
- 90657-Influenza virus vaccine, split virus, 6-35 months dosage, for intramuscular or jet injection use.
- 90658-Influenza virus vaccine, split virus, 3 years of age or above, for intramuscular or jet injection use.
- 90659-Influenza virus vaccine, whole virus for intramuscular or jet injection use for children and adults.
The 90660 Nasal Flu vaccine is reimbursed fee-for-service for members ages 5 to 49. Providers should follow CDC recommendations for use of this vaccine. Children under 9 years old should get two doses the first year they receive the flu vaccine. Gateway will pay an administration fee for both doses.
Billing Procedures – Medicare Assured®
The seasonal flu vaccine is a covered benefit for our Medicare Assured® members. Please continue to bill valid HIPAA compliant CPT and HCPC codes (90655 thru 90658, 90660 and G00008) for the seasonal flu. For reimbursement of the H1N1 vaccine administration, providers must submit the following code:
- G9141-Influenza A (H1N1) immunization administration (includes the physician counseling the patient/family)
Providers will be reimbursed per their contracted rate for both the seasonal flu and H1N1 vaccines.
If you have any questions or concerns, please contact your Provider Relations Representative directly or Provider Services at 1-800-392-1145 for Medicaid or 1-800-685-5205 for Medicare Assured®.
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