New temporary fee code for influenza immunizations

Effective October 1, 2020, a new temporary fee code for adult respiratory immunization will be available, which will allow adult influenza and pneumococcal immunizations to be billed in addition to an office visit (consult, prenatal visit, counseling etc.). 

Recognizing the pandemic has created significant additional expenses for doctors – including the purchase of PPE, adapting clinic spaces for staff and patient safety, and infection control practices –this change will provide the opportunity for physicians to address their patients’ health and chronic conditions, while also providing the immunization.

The temporary fee of $5.43 per immunization will allow a medically necessary visit to be billed in addition to the immunization. If the primary purpose of the visit is for immunization, the fee item B00010 (Intramuscular medications - $11.37) using ICD-9 code V048 for influenza and/or V05 for pneumococcal applies. A visit cannot be billed if the primary purpose is an immunization.

The end date of the temporary fee will be determined by the Provincial Health Officer.

Details of the new fee can be found below:

T10040: Respiratory immunization for patients 19 years of age or older..................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 visit is for immunization, bill fee item 00010
using ICD-9 code V048 for influenza and/or V05 for pneumococcal.