Billing Options for Flu Clinics

August 13, 2010 in Blog, Uncategorized by support Team  |  Comments Off on Billing Options for Flu Clinics

Years ago not many people would ever think to receive a flu shot from the place they fill their medications. CVS, Walgreens, and other retail pharmacy chains are trying to change patterns of receiving flu shots so they can make money on the flu shot as well as the visit for “other items” at their pharmacies. In many cases they only train their pharmacists on a few hour course. A medical assistant in a physician’s office whom administers vaccine has much more experience in giving vaccines to children than a pharmacist. Additionally, the physician can very there are no issues and if there are issues, they have the training to manage the situation in the best interest of the patient. The patient is also able to have the vaccine include with their medical record which is helps with continuity of care for the patient.

With that said, a flu vaccine provided by a medical assistant with a patient verification by the doctor, provides additional value than just a flu shot at a pharmacy. Patients need to be educated on this value so they understand the difference. If the patient is seen by the doctor, generally the coding should be a 99212, the code for the flu vaccine and the appropriate administration codes. As in any visit, the appropriate co-pay per the insurance company should be collected. The practice might consider policies to manage families with multiple patients. CPT codes for administration are accepted by most payers except for Medicare (Medicare has its own code). The administration code is based on the age of the patient, whether the physician counsels the patient or the patient’s family about the vaccine, and how the vaccine was administered. For children younger than 8 years old, CPT codes 90465 and 90466 are used to report/code vaccine administration when the physician provides education to the patient and/or the patient’s family. If the vaccine is intranasal or oral, codes 90467 and 90468 should be used for patients younger than 8 years old. If the patient is >8 years of age or no counseling provided to a patient 8 and under, then codes 90471 and 90472 should be used. 90471 is for administration of the first vaccine while 90472 is for administration of each additional vaccine. For vaccines administered via nasal or oral route and if the patient is >8 years of age or no counseling provided to a patient 8 and under, then codes 90473 and 90474 should be used. 90473 is for administration of the first vaccine while 90474 is for administration of each additional vaccine.

The ICD code most utilized is v04.81 for the flu vaccine alone. Seems like much to remember? No worries if using the physicianXpress system since the system is designed to automatically attach the appropriate diagnosis and CPT codes based on the coding rules described above. All an office needs to do is to attach a vaccine to the visit and the rest is managed by the system as well as the Doctor Office Management, Inc. billing team.

Once the billing policies are confirmed for flu clinics, the practice needs to plan how they will administer/manage their flu clinic. Questions to ask, how many patients do we expect to receive the vaccine? Should we have flu vaccine clinics? If so, how do we communicate the clinics? Voice broadcast? E-mail campaign? The physicianXpress system allows practices to use easily send out a voice broadcast and/or e-mail campaign to patients. For more information on the physicianxpress system go to

Some reference sites to gain further background on flu vaccine:

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