Temporary billing changes for providing flu shots to adults during COVID-19

A temporary fee change to increase compensation to physicians for delivering respiratory immunizations to adults has been approved. This increase will help offset the additional expenses incurred for providing flu shots during the pandemic. The two new temporary fees are available effective October 1, 2020, with an end date of April 30, 2021.

Scenario 1 – Respiratory immunization for adults (with visit)

Fee item T10040 allows a flu shot to be billed in addition to an in-person visit for an unrelated reason (e.g. office visit, prenatal visit, counseling,  etc.). A visit cannot be billed if the primary purpose is an immunization (in that case, bill T10041).

T10040  Respiratory immunization for patients 19 years of age or older (with visit) .......... $5.43

Notes:

i) Payable for Influenza (using ICD-9 code V048) and Pneumococcal (using

ICD-9 code V05) immunizations.

ii) Payable in full with an office visit.

iii) If the primary purpose of the service is for immunization, bill fee item

10041 using ICD-9 code V048 for influenza and/or V05 for pneumococcal.

Scenario 2 – Respiratory immunization for adults (without visit)

Fee item TB10041 can be billed when the primary purpose of the service is to provide a flu shot. It is not payable with any office visit.

TB10041 Respiratory immunization for patients 19 years of age or older (without visit)…..$14.00

Notes:

i) Payable for Influenza (using ICD-9 code V048) and Pneumococcal (using

ICD-9 code V05) immunizations when the primary purpose of the service is

for immunization.

ii) Not payable with an office visit.

Billing tip: Fee code TB10041 - Respiratory immunization for patients 19 years of age or older (without visit) is not yet active. A billing alert will be sent out once the anticipated implementation date is known.

It is recommend that you wait to submit your billings for TB10041 until the fee code is active. This will avoid  having to debit and resubmit. Many of you may have already billed under fee code 00010 ($11.37) for influenza or pneumococcal immunization in adults since October 1. If you wish to resubmit under this new fee code once it is active, you can debit the 00010 billing in preparation.