Vaccine billing

September 2022

Developed by the Health Industry Collaboration Effort (HICE) Encounters Standardization Team, this training tool helps healthcare organizations understand correct billing processes and educate service providers on proper claims submission for vaccines. Vaccine billing is a leading cause of duplicate encounter submissions. These best practices help organizations reduce the number of duplicates.

Author

Health Industry Collaboration Effort (HICE) Encounters Standardization Team

Why use it

Improper coding, such as repeated procedure codes on claim lines, can trigger a duplicate error in an encounter submission. The Vaccine Billing Best Practice provides clear and consistent guidance for various scenarios that occur with immunization services. Use this presentation as a quick tool and resource when coding encounters.

Who it’s for

The Vaccine Billing Best Practice is intended for all healthcare organizations, including health plans, provider organizations, and delegates that work with claims or encounters for vaccines.

Key take-aways

This presentation provides information and examples for:

  • Initial and subsequent vaccines / add-on codes
  • Category 1 and Category 2 administration and examples / mixing and matching of administration and counseling
  • Samples of data submitted in X12 837 format
  • CMS – Medically Unlikely Edits (MUE)

Have edits or additions for this resource? Please let us know.

IHA’s Resource Hub is made possible through a grant from Health Net, LLC’s Encounter Data Improvement Program.

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