HCPCS Code G0008: Administration of Influenza Virus Vaccine

## **HCPCS Code G0008 documentation requirements** HCPCS Code G0008 documentation requirements primarily focus on accurately recording the administration of the influenza vaccine. Key elements include: - Documentation should clearly specify the administration of the influenza virus vaccine, distinct from the vaccine product itself. - On the CMS-1500 claim form, the G0008 code must be entered in Block 24D for the vaccine administration. - Claims should include ICD-10-CM code Z23 (Encounter for immunization) to indicate the service as a preventive immunization. - When using roster billing as a mass immunizer, the roster should include the provider’s name, NPI, date of service, and patient details (name, Medicare Beneficiary Identifier [MBI], address, date of birth, sex), along with the patient’s signature or “signature on file.” - Documentation should confirm the place of service and that the assignment was accepted, following CMS claim form instructions. - Providers must ensure documentation is complete and accurate to avoid claim denials, including correct coding and use of modifiers if multiple vaccines are administered during the same encounter.

## **HCPCS Code G0008 billing requirements** HCPCS Code G0008 billing requirements are as follows: - This code is used for billing the administration of the influenza virus vaccine under Medicare Part B. Providers must accept assignment on all vaccine and administration claims. - There is no deductible, coinsurance, or copayment for the beneficiary when billed using this code. - A physician order or direct supervision is not required under Medicare rules, though state law requirements must still be followed. - If a physician administers the vaccine as the sole service, an office visit cannot be separately billed; however, if a significant, separately identifiable E/M service is provided on the same day, it may be billed with modifier 25. - When multiple vaccines are administered at the same encounter, an administration fee may be billed for each vaccine. - Claims must include ICD-10-CM code Z23 (Encounter for immunization) to indicate the vaccine administration as a preventive service. - For mass immunizers, roster billing is allowed—claims use a roster to document Medicare beneficiaries immunized. - Roster billing must separate influenza and pneumococcal vaccines into different claims, and no additional services should be included on those roster claims. - The payment rate for G0008 varies by geographic location and is updated annually by CMS.

## **Other relevant codes** - **90471**: Immunization administration (injection), single vaccine or combination vaccine/toxoid, primary - **90472**: Immunization administration, each additional vaccine (use with 90471)

### **References** Centers for Medicare & Medicaid Services. (n.d.). Medicare claims processing manual: Chapter 18 – Preventive and screening services crosswalk to old manuals. U.S. Department of Health & Human Services. https://www.cms.gov/regulations-and-guidance/guidance/manuals/downloads/clm104c18aug_prevsvcvac.pdf