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Q:

Is the Medicare flu shot code G0008 standard for all insurances or just Medicare?

A:

In our experience, only Medicare requires the use of G0008 for administration of a flu shot. Bill G0008 in addition to the vaccine product code (90657 - Flu vaccine, 6-25 months; 90658 - Flu vaccine, split, 3 years and above; and 90659 - Flu vaccine, whole). If the patient comes in specifically for a flu shot, do not bill an evaluation and management service. If the patient comes in for another service and the flu shot is provided as well, you would bill 99213 (or the appropriate evaluation and management service code), 90658 and G0008.

For other payors, you should bill the appropriate administration code from the Medicine Section of the Current Procedural Terminology (90471 or 90472) in addition to the vaccine code. For example, you would bill 90471 and 90658 together. According to CPT Guidelines, you may bill an evaluation and management service code in addition to the administration of the vaccine if appropriate.

These services are modifier "-51" exempt.

Mary Beth Black, CPC
Senior Associate

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