Practice Strategy Tip: Billing Accuracy for Vaccines

Billing for vaccines by pediatric and adult practices needs constant attention and updates. Many practices “set it and forget it” once they implement a vaccine administration program. Be sure to revisit your vaccine billing once a month to make sure you are keeping up with periodic changes. Below is a list of areas to watch:

Know your CPT code

When newer versions of vaccines are introduced, they are assigned a new CPT. For example: Gardasil is billed with 90649 but Gardasil 9 is billed with 90651. Don’t make the mistake of billing a newer vaccine with an older CPT code.

Update your fee schedule

Vaccine manufacturers have price increases on a regular basis. When you receive notice your vaccine price is increasing, increase your fees accordingly.

Check your reimbursements

You know what you are paying for vaccines each month but do you know what you are collecting from each private payor for each vaccine? Make sure you collect more money than you pay for each vaccine.

Bill the administration codes

There are costs related to vaccines that are beyond just the price you pay for the vaccine. Bill the appropriate administration code for the vaccine so you can cover the cost of items such as storage, nursing time, and VIS sheets.

Mark your calendar with reminders about rebates

Vaccine Connect and GSK pay rebates to practices every 6 months and the flu vaccine rebate once a year in the fall. If you receive additional rebates, make sure you know the timing of these and follow up with organizations who may delay payment.