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 90658 90660 | G0008 for intramuscular administration 90473 for intranasal or oral administration | Actual Acquisition Cost | $13.23 $8.57 |
| Pneumococcal | 90732 | G0009 for intramuscular administration | Actual Acquisition Cost | $13.23 |
| H1N1 | 90663* (Does not need to be reported) | 90470 for any route of administration | $0*
(Vaccine Supplied for Free) | $13.23 |
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?
Yes.
Q4: Can an oral prescription be used for a pharmacist to administer a vaccine?
Yes.
Q5: Can a written prescription be used for a pharmacist to administer a vaccine?
Yes.
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.
