NYS Medicaid Program Pharmacists as Immunizers Billing Guidance on Executive Order #29 State Disaster Emergency
Effective October 28, 2009, Governor Paterson issued Executive Order #29 declaring a disaster emergency for the State of New York. This Executive Order authorizes, for thirty days, the temporary suspension or modification of several laws and regulations related to licensed professions, including pharmacists, which affect the administration of H1N1 and seasonal influenza vaccine administration. This Executive Order expired April 17, 2010.
The NYSDOE Office of the Professions (OP) has issued the following information, "Summary of NYS Executive Order 29 Declaring a Disaster Emergency in the State of New York" (http://www.op.nysed.gov/exec-order29-h1n1.htm ) which summarizes changes affecting pharmacists. Please review the OP summary as it contains important information regarding administration of vaccines by pharmacists.
Below you will find information regarding Medicaid billing for administration of vaccines by pharmacists relevant to Executive Order #29. This guidance is in addition to Medicaid policy established for the administration of vaccines by pharmacists found in the Medicaid Pharmacists as Immunizers Fact Sheet . This guidance document will be continuously updated as we learn more about the effects of the Executive Order on Medicaid pharmacy billing.
Retroactive to October 28, 2009 and only until April 17, 2010, the Medicaid program can be billed for pharmacist administration of H1N1 and seasonal influenza vaccine, under the following conditions:
- Certified pharmacists may administer vaccinations against 2009 H1N1 influenza and seasonal influenza for patients between six months and 18 years of age.
- Non certified pharmacists may administer vaccinations against 2009 H1N1 influenza and seasonal influenza at Points of Dispensing (PODs) which are overseen or approved by the NYS Department of Health or local health departments and operated under the medical supervision of physicians, physician assistants or nurse practitioners. Certified pharmacists can also administer vaccines in PODs. However, Medicaid cannot be billed for the administration of vaccines by pharmacies in this situation unless it can be documented that the POD is not billing Medicaid, the pharmacist is not volunteering their time, and the POD has agreed to, and prearranged, for the billing pharmacy to have their pharmacists administer seasonal and H1N1 influenza vaccine to Medicaid fee for service enrollees and bill Medicaid for these services.
- The H1N1 vaccine is being provided free of charge by the Centers for Disease Control and Prevention (CDC). Therefore, Medicaid will not reimburse providers for H1N1 vaccine.
- The Seasonal Flu vaccine for individuals under the age of 19 is being provided free of charge by the Vaccines for Children (VFC) program. Therefore, Medicaid will not reimburse providers for the Seasonal Flu vaccine for individuals under the age of 19. For VFC enrollment information, go to: http://nyhealth.gov/prevention/immunization/vaccines_for_children.htm.
The following chart describes the codes and fees that are reimbursable to pharmacies for the pediatric administration of seasonal and H1N1 flu vaccines:
| Immunization Type | CPT Code for Vaccine | CPT Code for Administration | Amount Paid for Vaccine | Amount Paid for Administration |
|---|---|---|---|---|
| Ages between 6 months and 19 years | ||||
| Seasonal Flu | (Is not reported) | G0008 for intramuscular administration 90473 for intranasal or oral administration | $0+(Vaccine Supplied for Free by VFC) | $13.23 Bill vaccine administration code only (do not bill vaccine procedure code) $8.57 Bill vaccine administration code only (do not bill vaccine procedure code) |
| H1N1 | (Is not reported) | 90470 for any route of administration | $0* (Vaccine Supplied for Free by CDC) | $13.23 Bill vaccine administration code only (do not bill vaccine procedure code) |
+ Please note: the seasonal flu vaccine is provided free through the Vaccines for Children (VFC) program. Therefore, while the administration of the seasonal flu vaccine is reimbursable by Medicaid, the vaccine product itself is not.
* Please note: the H1N1 vaccine is provided free by the Centers for Disease Control and Prevention (CDC). Therefore, while administration of the H1N1 vaccine is reimbursable by Medicaid, the vaccine product itself is not.
