General Article

Flu Coursing Its Way Through the US – Providers Need to Be Proactive

Flu Coursing Its Way Through the US – Providers Need to Be Proactive

The flu outbreak in the U.S has reached threatening proportions, and according to the U.S. Centers for Disease Control and Prevention, 7.3% of deaths last week were caused by pneumonia and the flu. The CDC is concerned about the high level of flu activity that has crossed the epidemic threshold of 7.2% and spread across nine out of the ten regions of the U.S. Public health authorities have advised the public to take vaccines against influenza A and influenza B. Healthcare providers should take special care to educate their patients on the seriousness of the situation and urge them to get their flu shots, if they haven’t taken them already. The greatest risk is for children, those with an underlying health condition, and senior citizens. Statistics for this season shows that H3N2, an A strain is more rampant, while the B strain is responsible for around 20% of the cases. Symptoms include fever/fatigue, and cough, and if these occur, people are advised to immediately start taking anti-viral medications.

The ACIP (Advisory Committee on Immunization Practices) has advised that all people 6 months old and older should be given annual influenza vaccination.

Coverage for Medicare Beneficiaries

Medicare Part B (Medical insurance) provides coverage for a flu shot once per flu season in the fall or winter. This can be availed by all Medicare beneficiaries. A physician’s order or a physician’s supervision is not mandatory to receive coverage. However, this may depend on individual state laws. Additional vaccinations also may be covered, if they are medically necessary. The Part B deductible does not apply in this case, so beneficiaries need not pay anything for a flu shot.

Any entity or individual meeting state licensure requirements can provide the influenza vaccine to Medicare beneficiaries enrolled under Part B and receive payment for the same. The reimbursement includes the cost of vaccine and the payment for vaccine administration.

The payment for influenza virus vaccine is based on the same rate as the HCPCS code 90471 (immunization administration, Hepatitis B virus(HBV) vaccine) as priced on the physician fee schedule database.

Providers of influenza vaccine will have to report code G0008 when billing Medicare. So, it is understood that the reimbursement for vaccine administration will vary according to the provider’s locality.

Pharmacists and nurses employed by a physician/pharmacy can administer the vaccine using the physician’s/pharmacy’s provider number. In case they are not representing a physician/pharmacy and are not working for them, they will have to obtain a provider number of their own and bill the carrier/AB Medicare Administrative Contractor (MAC) directly.

Providers and Suppliers That Can Bill Carrier/AB MAC





Self employed nurses

Public health clinics

Non-skilled nursing homes

Mass immunization providers

Assisted living facilities

Senior centers

Shopping malls

Non-certified home health agencies

The last three are possible venues where a mass immunization provider can offer vaccination services.

Providers That Can Bill Intermediaries


Certified home health agencies (HHAs)

Skilled nursing facilities (SNFs)

Hospital-based or independent renal dialysis facilities (RDFs)

Comprehensive outpatient rehabilitation facilities (CORFs)

Providers Need To Be Proactive and Ensure That People Get Their Due Vaccinations

A survey conducted by the CDC reveals that not even half of the population was vaccinated by early to mid-November 2012. Lower flu vaccination coverage was observed among Hispanic adults. The CDC concluded that more than 60 percent of Americans did not take advantage of flu vaccination and the protection it guarantees against influenza and its ill effects. Providers are urged to not only recommend the flu shots to all their patients, but also see to it that their patients, staff and they themselves get vaccinated as soon as possible.