NYS Medicaid Program Pharmacists as Immunizers Q & A's
Q1. What billing codes are used for vaccines and administration?
The following chart describes the codes and fees that are reimbursable to pharmacies.
|Immunization Type||CPT Code For Vaccine||CPT Code for Administration||Amount Paid for Vaccine||Amount Paid for Administration|
|Age 18 and older|
|Seasonal Flu||90656 |
|G0008 for intramuscular administration|
90473 for intranasal or oral administration
|Actual Acquisition Cost||$13.23|
|Pneumococcal||90732||G0009 for intramuscular administration||Actual Acquisition Cost||$13.23|
(Does not need to be reported)
|90470 for any route of administration||$0*
(Vaccine Supplied for Free)
Q2: What quantity and day supply are used when billing?
Quantity = 1, Day Supply = 1.
Q3: Can a standing order be used to document the order for administration?
Q4: Can an oral prescription be used for a pharmacist to administer a vaccine?
Q5: Can a written prescription be used for a pharmacist to administer a vaccine?
Q6: Can a total fee be billed?
No. Administration of a vaccine and the cost of a vaccine must each be billed with a separate procedure code. They can be billed point of sale on the same claim using NCPDP format.