Procedure Code and CVX Codes Assigned to H1N1 Vaccine

H1N1, or the Swine Flu Virus, is persisting, according to officials, and has continued to cause outbreaks throughout the country despite the arrival of summer. Depending on the forthcoming details of the H1N1 vaccine, this may present additional challenges for your practice during the busy flu season.

The federal government recently announced that a new vaccine for H1N1 will become available as early as this coming October, and five companies are in the process of manufacturing the H1N1 vaccine here in the U.S.: Sanofi Pasteur, Novartis, GSK, Medimmune, and CSL.

Preliminary information and recommendations for H1N1 vaccinations have been posted by the Centers for Disease Control and Prevention (CDC). A procedure code and CVX codes have been assigned to the H1N1 vaccine. According to the CDC:

CVX code 128 will be used for all formulations of Influenza, H1N1-09 vaccine.There are 3 other CVX codes for this vaccine (125- live nasal, 126-injectable-preservative free and 127-injectable). These also map to this CPT code. In practice, CPT 90663 shall be mapped to CVX 128. If the vaccine is stored in the registry as one of the other vaccines (CVX 125,126 or 127) and the registry must send a CPT code to another system, then use CPT code 90663.

Based on initial recommendations, the plan is to administer the H1N1 vaccine to all patients ages 6 months to 24 years of age, pregnant women, as well as to care givers (i.e. parents, teachers, and day care workers) of children under the age of 6 months. CDC advisers also have developed recommendations for priority groups in the case of a shortage of the vaccine. 

There are still many unknowns about how and the H1N1 vaccine will be distributed or administered, whether it will be administered to all children at schools, through a public health campaign, or through private channels, such as private practices. Also, not known yet is whether people will require one or two doses of the vaccine. For planning purposes, the CDC recommends assuming that people will require two doses and that they must fall 3 to 4 weeks apart. While there are still unknowns, PCC recommends preparing your practice in the case that you may need to administer the H1N1 vaccine. 

Depending on the billing and practice management system your office uses, additional configuration options may be needed to ensure proper billing documentation and vaccination protocols for your practice. PCC plans to stay informed of this issue and keep our clients apprised, and make sure they have the ability to track and report the administration of H1N1 vaccines, as well as alert families and recall patients for both the need for the Seasonal flu vaccine, as well as the H1N1 vaccine.

PCC Partner system users planning to provide H1N1 to patients should check their procedure table to make sure 90663 has been added. The PCC Partner practice management system does not use CVX codes for vaccines, so you do not need to do anything with this code. We have provided it because some other systems require it.