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How to Bill for Flu Shots

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Billing Flu Shots to Medicare and Commercial Insurance Companies

How to bill flu shotsSince it is now flu season I have been getting a lot of questions on how to bill flu shots to commercial insurance companies and Medicare. The codes used for a particular vaccine will vary depending on intramuscular vs. intranasal use, age of patient, formulation, preservative free, and split or live virus. If you are unsure of what code to use I suggest looking at the package information
that came with the vaccine. Usually you can find the code on the packaging, and if you can’t find it in the documentation then call the supplier.

This is how most of our primary care practices bill for flu shots. Your situation may be different so make sure to check all the influenza vaccine codes 90654-90668 and use the appropriate code for the vaccine administered to the patient.

Commercial Insurance Carriers

90471 Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid)
90658 Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use

Medicare

G0008 Administration of Influenza Virus Vaccine
Q203x Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use

Keep in mind that there are several codes for the flu vaccine when you bill for Medicare flu shots. The code you use is dependent on the manufacturer of the vaccine. Replace the code above with the correct vaccine code below.

Here is the list of the new Medicare Flu Vaccine codes for 2011. Choose the code based on the manufacture:

Q2035 Afluria Vaccine: Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Afluria)

Q2036 Flulaval Vaccine: Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Flulaval)

Q2037 Fluvirin Vaccine: Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Fluvirin)

Q2038 Fluzone Vaccine: Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Fluzone)

Q2039 NOS (Not Otherwise Specified) Vaccine: Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Not Otherwise Specified)

Check out the short video we made about coding for the Medicare flu shot CLICK HERE

Pediatric Billing

Flu Shot Pediatric BillingIf a child is under the age of 9 and has not previously received a flu shot, then usually two shots are given one month apart. After the initial series, in subsequent years only one shot is needed. When billing for the initial flu shot keep in mind that insurance should pay for both the initial flu shot and the flu shot given 30 days later. Be sure to follow up with the insurance companies if reimbursement is not issued for the second shot of the initial series. Typically these are denied but can be paid with a simple appeal or phone call correcting the denial.

90471 Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid)

Use the age appropriate codes as needed.
90657 Influenza virus vaccine, split virus, when administered to children 6-35 months of age, for intramuscular use
Or
90658 Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use

CPT copyright 2010 American Medical Association. All rights reserved.
CPT is a registered trademark of the American Medical Association.

65 Responses to “How to Bill for Flu Shots”

  1. Tina says:

    Our clinic has been asked to come to a factory to give flu vaccines to their employees. We are in Mississippi. Our providers want to bill the workers’ insurance. Can we do this legally if we are giving them in the workplace? We just want to be sure we don’t do anything wrong.

    • It would be easier to just collect a cash payment from the employees or better yet if the factory would pay you for the flu shots becasue they would benefit much more than the costs of the shots by employees not calling out sick.

      But since you want to bill the employee’s insurance I don’t see an issue with that. I would make sure to use the correct place of service when you bill the admin code and the vaccine, POS 60.

      That said since you are dealing with the same insurance company for all the employees I would call the insurance and specifically ask them how to bill for the flu shots. That way there is no question that is is being done correctly to get you paid fast.

      • Tina says:

        Thank you. They have BCBS so I will call them and make sure there is no problem.

        • Sound like a plan to me! You don’t get paid much for the flu shots so you want to make sure they fly right through and you don’t have to do any follow-up. Contacting BCBS is what I would do. Hope it all goes well for you!

  2. Kim says:

    Is it correct to charge a “nurse visit” 99211 when administering the Flu vaccine?

    • Kim —

      No, gone are the days when insurance companies would pay for a “nurse visit” and an administration charge along with the vaccine.

      You can only bill for the admin and vaccine. Insurance will reject the 99211. –Manny

  3. Jeri says:

    I work for an allergy and respiratory clinic in IL, but a few of our doctors are primary care physicians as well. They believe with the lung issues our patients have a second flu shot in a flu season is medically necessary, but we are not getting payment from medicare. I have appealed each patients flu vaccines twice and still no luck. I didn’t know if there is a trick or some certain information they are looking for to help get these paid. Thanks for your time!

    • According to the CMS website “Medicare may provide additional flu shots if medically necessary” see this link:

      https://www.cms.gov/Medicare/Prevention/PrevntionGenInfo/Downloads/MPS_QuickReferenceChart_1.pdf.

      What are the denial reasons for the appeals?

      You might also want to look at HCPCS modifier –SC Medically Necessary Service or Supply to see if that allows for the additional benefit.

      Did you try submitting the second flu shot with the -76 modifier for repeat procedure?

      Even when you submit the medical documentation and an appeal letter what is their specific response?

      Please be sure to check with your local Medicare Administrative Carrier. They should have information on their requirements to bill this properly.

      • Jeri says:

        We have sent in notes along with medical necessity letters but they state in the denil letter from the appeal that it is not covered by medicare. The information recieved does not support the need for the services. That is really all the further they go as to why it is denied.
        We have not tried either of those modifiers on these flu vaccines. Would we attach a modifier on the flu vaccine, administration, or both?
        I will also try our Administrative Carrier to see if they have any ways to help me.
        Thank you!

  4. R. Haney says:

    I work for a specialty practice of Nephrology. How do you bill NC Medicaid for patients who are seen for an office visit, usually a 99214, and then also obtains a flu shot while they are here. We have billed the 99214 with modifier 25 attached to the E/M code with different diagnosis from the vaccine for influenza. We use Q2036 for Flu-zone and also 90471 for administration but Medicaid paid the office E/M code but no reimbursement for the vaccine or administration. Can you help please? Thanks

  5. Jennifer Rhodes says:

    We are trying to bill Tricare for the Nasal Flu Mist – we are unsure of the units of measure?

  6. Diane says:

    Manny – Thank you so much for all the info you provide, it’s extremely helpful! I work for a public health/home health agency and am trying to bill Medicare for the flu shots provided this past fall. What Q code do I use for the Fluzone High-Dose(IIV3)? All the information I find lists it with the CPT code of 90662 but I do not find a Q-code for Medicare. Q2033 is the only code that has a payment allowance high enough to cover our cost. Do I use the Q2039 with our cost plus the administration G0008?
    Thank you!
    Diane

  7. Ivieh Cod says:

    Hello Mr. Manny,
    I find your blogs very informative and helpful. I have started to follow your page in facebook.
    I am from a home care and we provided flu vaccines in some senior communities. I billed medicare using G0008 and Q2038. I will be billing Private Insurance like Aetna, Humana, HAP, Priority Health and BCBS Freedom Blue. Should I use the same codes or it should be different? Also we are using UB-04 forms to bill these private insurances. Should there be treatment authorization codes (line 63 of UB-04) and Value Codes (line 39 of UB-04) or i can just leave that one blank? Thank you very much and hoping to hear from you very soon.

    • Thanks for the Facebook LIKE! The codes you are using are correct for Medicare or Medicare Advantage programs. For patients without Medicare I would use 90471 and the appropriate flu vaccine code such as 90658. Some of our practice do home care but all our billing is done on CMS-1500 so I can’t help you much with your form.

  8. Mallory B. says:

    Thank you so much for doing this. I work for a pediatrics office in GA and I am having trouble getting Medicaid to pay for vaccines and some Well Baby Care visits. Did something change as to how we should submit these claims? I enter them electronically. I add the EP modifier. Sometimes they pay them but most times they don’t.

    • Mallory do you participate in the Vaccine For Children (VFC) program in your state where the vaccine is provided by Medicaid? That is the only reason I can think of that your vaccines are not getting paid without seeing the EOB denial codes.

      • Asia Tucker says:

        Manny , love your blog. It is very informative!
        Mallory, did you ever figure out what the problem was?

        My practice is in GA as well and we are having a problem with Medicaid/VFC paying for the vaccine admin (90460) fee. We are billing the Vaccine CPT along with the 90460. We use EP modifer and 99 POS. Can you tell me what we are doing wrong? Thanks in advance!

        • Asia each state can have their own requirements for billing Medicaid. As I understand it, Georgia Medicaid wants you to bill a VFC with the vaccine CPT code, 90460/90461, an EP modifier and a POS 99 (Other Place of Service). Is that correct?

          Some states like 90471/90472 for the admin of vaccine and I have not come across any plan that wants a POS of 99. Usually its the office POS 11.

          Also some plans pay on the admin code while others pay on the vaccine code. Whichever code Medicaid pays on they only pay the $14-$28 for administering the vaccine since the vaccine is provided by the state.

          The only thing I can say is to call your Medicaid rep (which I know may not be the easiest thing to do) or look on the GA Medicaid website. We have usually have found how to bill services and procedure on the websites.

  9. Tim B says:

    We have a local employer wanting us to immunize employees for influenza and they want the pharmacy to bill their medical insurance thru the wellness program. We contacted Anthem and inquired about this and was told only physicians can bill medical insurance. The Influenza vaccine is not covered by the employee’s prescription drug card. So, how do you go about billing someone’s wellness program / medical insurance?
    Thanks!

  10. Tim N says:

    We are a medical clinic that has homebound patients on hospice. The hospice service does not supply flu shots. The hospice nurse would like to pick up a flu shot from our clinic and go give it to the patient.
    I’m fine with this but can we still bill medicare for the flu shot even though it was given in the patient’s home by a nurse who is a hospice nurse and not an employee of our medical clinic?
    If so then how is it coded?
    Thanks!

    • Good question Tim. The issue here is that the nurse does not work for you. It would be no problem to bill if the nurse was in your employ. When dealing with Medicare you want to be sure you do it right.

      If there were only a 2 or 3 patients I would think about just not even charging for it but with that the other thought I would have is about malpractice coverage.

      What if for some reason the patient has a bad reaction to the shot. The family blames your practice because you provided the vaccine. But wait, you did not provide the service, does that mean that your malpractice carrier will not cover you? Well you always have your general liability insurance coverage. But wait again, they may not cover you because this has to do with a medical issue.

      I am not a lawyer or even play one on TV but we had a similar situation come up and decided not to even provide the vaccine on the remote chance something would go wrong because after talking to our carriers there would be no coverage.

      I would encourage you to talk to your insurance companies and attorney before going forward. And yes it is a shame we have to do that.

  11. Bridgot says:

    I have a question about doing an off site flu clinic. We have a local college that would like us to come to an open house that they are having and offer flu shots to the students with and without insurance. My question is, would the billing be any different for giving the shot outside of the clinic? We bill place of service 11. Would we have to use a different place of service?

  12. Melissa Lindsey says:

    How do you bill a flu shot under Wellness for Blue Cross? Patient did not see the doctor only got a Flu shot. We have not had flu shots in years and I have forgotten “Wellness” rules.
    Thanks

    • Melissa, unless your Blue Cross has some special rules in which case I would check with them, for commercial insurance I would bill 90471, Admin of Vaccine, with the appropriate flu vaccine code such as 90658, with a DX of V04.81 on both CPT codes. Don’t use a well check diagnosis like V70.0 or V20.2 as may say that they had a full well check based on the DX. You know how those insurance companies are.

  13. Diann Grissom says:

    Hi!
    I work for a hospital. Can you get reimbursed for giving vaccines to employees and their family members? We administer free of charge to all employees and their family members who reside within the home. I was always told you cannot bill for flu vaccines to employees in a hospital.
    Thanks

    • Diann what I have heard is that if you require a flu shot as a condition of employment you should not bill that to insurance. That is basically what is happening at hospitals and large medical practices. It would be a cost of doing business. Family members may be a different story since they are not employees. As a management decision the facility may just decide to cover the cost of each family member.

  14. Samra says:

    Hi
    I have a simple question. Who can bill for the flu vaccines? We have RN’s in the office that would like for us to submit the flu vaccine to patients insurance?

  15. John Tracy says:

    Have been pleased to see your good advice so far.

    We have been billing flu shots this year with and without a separate visit, generally 99213 or 99214. We bill through Palmetto GBA, who is notorious for errors.

    On a recent page of EOBs, we were paid for several and not paid for 4 submissions. In each case the remark code was M25 on the Q2036. We billed G0008, 90656 and Q2036 for all. The G0008 was always paid, the 90656 was never paid and the Q2036 was paid 2 of 6 times. In each case, we used V04.81.

    One suggestion was to use modifier 25, though we have not needed this in past years and the paid claims this year did not have it. Can you understand this and advise?

    • First lets see what Medicare Remark Code M25 states:

      M25

      Payment has been adjusted because the information furnished does not substantiate
      the need for this level of service. If you believe the service should have been fully
      covered as billed, or if you did not know and could not reasonably have been
      expected to know that we would not pay for this level of service, or if you notified the
      patient in writing in advance that we would not pay for this level of service and he/she
      agreed in writing to pay, ask us to review your claim within 120 days of the date of this
      notice. If you do not request an appeal, we will, upon application from the patient,
      reimburse him/her for the amount you have collected from him/her in excess of any
      deductible and coinsurance amounts. We will recover the reimbursement from you as
      an overpayment.

      Well that denial description is as clear as mud.

      I am going to make the assumption that when you are billing a level 3 or 4 E/M code for problems the provider is addressing with the patient, you are not including the V04.81 diagnosis code with the office visit CPT code. If you have that could be causing problems.

      Modifier 25 does not apply in this case.

      Now lets look at the flu codes you billed:

      G0008 Administration of Influenza Virus Vaccine

      90656 Influenza virus vaccine, split virus, preservative free, when administered to individuals 3 years and older, for intramuscular use

      Q2036 Flulaval Vaccine: Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Flulaval)

      Are you saying that you billed both a 90656 and a Q2036 on the claim for the same patient? If so you are billing two flu shots.

      Let me know if this helps or you have additional questions. Also check with Medicare as they have lots of good information on billing the influenza vaccine on their website.

  16. Jodi says:

    Hi Manny,

    I just happened upon your website and I must say that the information that you provide is great. The coding profession needs more selfless individuals like yourself. I subscribed to your YouTube account and look forward to following you. You are a great man and what you provide is invaluable. On behalf of all of the coders and medical professionals that you have helped I would like to “Thank You!”

    • Jodi thank you very much for your kind words. I wish I had more time make videos, write blog posts and teach. Several on my teammates also have a passion to help coders and billers and do so by teaching medical billing and coding to people at our local community college and at events around our area. Thanks again. –Manny

  17. Michele says:

    Manny , I heard that you can bill the flu quesitionaire(4 quesitons) that patients have to complete prior to getting the vaccine. Is that true and if so what is the code?

  18. Tr says:

    Can you charge say $18 for a cash price for a flu shot and if billing to insurance say $32?

    • Good luck getting $32 from an insurance company for a flu shot. I don’t know if I have seen a reimbursement that high in recent years. Some practices do offer a time of service payment discount which sound like what you would like to do. Check your insurance contract to see exactly what you can and cannot do.

  19. Lal Martell says:

    We started administrating vaccines for children [Hep A 90633, Diphtheria Tetanus Toxoids 90700, Rotavirus 90680, MMR 90707, etc. As I read about the admin codes to use, they become confusing and sometimes I feel there is information missing or out of sequence – i.e., if I bill for the CHCUP 99382 with the Hep A and the MMR, maybe the Rotavirus, can you address me where to read how to bill or give me an example. Thank you very much!

    • Well Lal there are a couple of ways you can bill your well child visit with immunizations.

      You can bill using the vaccine admin codes 90471 and 90472 as follows:

      99382
      90471
      90472 x2
      90633
      90707
      90680

      You can also bill using 90460 and 90461 as follows:

      99382
      90633
      90460
      90707
      90460
      90461 x2
      90680
      90460

      So what is the difference? This is what CPT says . . .

      90471 Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid)
      90472 Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure)

      90460 Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first or only component of each vaccine or toxoid administered
      90461 Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; each additional vaccine or toxoid component administered (List separately in addition to code for primary procedure)

      Use the administration codes that best describe what you are doing at your practice. Make sure you document well.

      We usually use a diagnosis code of V20.2, Routine infant or child health check, which includes developmental testing of an infant or child, age appropriate immunizations, routine vision and hearing testing. That ICD-9 code would go with all the CPT codes.

      It would also be appropriate to use the individual vaccine ICD-9 codes with the vaccines instead of V20.2. The claim for the vaccines would look like this:

      90633 V05.3 Need for other prophylactic vaccination and inoculation against single diseases, viral hepatitis
      90707 V06.4 Need for prophylactic vaccination and inoculation against combinations of diseases, measles-mumps-rubella [MMR]
      90680 V05.8 Need for other prophylactic vaccination and inoculation against single diseases, other specified disease

      Check with your insurance carriers on how they would like these visits billed. Each may want something a bit different.

      Let me know if this was helpful or if you have more questions. –Manny

  20. Susan says:

    Hi Manny,

    I have just started an online Medical Coding and Billing course. I am very excited to begin my new career. If you have any advice for a newbie it would be appreciated! I found you on twitter and enjoy reading you comments. All my books teach the ICD – 10 Codes. Thank you!

    • Susan good people are always going to be needed in medical billing and coding. With all the new rules and changes the government and insurance companies will be implementing over the next few years and the transition to ICD-10, I believe there will be job security in our field. The key is to make sure you keep studying and gaining experience. We have several team members here at Capture Billing that have 10-20+ years of medical billing and coding experience and hardly a day goes by where we all don’t learn something new because of the ever changing world of healthcare. Our people read a lot, get ongoing training and have access to great resources in order to do their jobs properly. You really must have a good attention to detail to succeed.

      Now taking classes is a great start, but only a start. It will take you another good year or so in a medical billing position, getting hands on experience, to really be able to understand all the concepts. The learning will then continue throughout your career. Remember, Attention to Detail.

      Best wishes to you –Manny

  21. Clara says:

    Hello, Manny

    What is the right CPT code for flu shot for medicaid patients?

    • Usually you can bill Medicaid as you would commercial insurance. That said, each state can have their own rules on how they want the flu vaccine billed. Additonally, most states have a Vaccines For Children (VFC) program that provides the influenza vaccine at no cost to the patient. You will have to check with your states Medicaid. You should be able to find the billing information on their website.

      Hope this helps –Manny

  22. Rudy says:

    Hi,
    I work for a hospital and was told that we can bill a level 1 or 2 for just a flu vaccine. Is that correct? Seems a little unreasonable for just a flu vaccine without having anything else.

    • Rudy, I want to understand clearly, are you saying that if a patient comes into your hospital just for a flu shot and no other service is performed the hospital administration is telling you to bill up to a level 2 visit along with the flu shot? How do you know if its a level 1 or level 2? Are you looking at the chart notes? Level 1 can be for a nurse and level 2 for a physician, NP or PA. Sounds like you are just suppose to pick one regardless?

      That said, if the only service you are providing is giving a flu shot, at best you can only bill a level 1 but even that is not billed any more these days. The administration of vaccine code 90471 or G0008 for Medicare is about all you can bill allong with the influenza vaccine codes.

      Is there anything else to this story? Are they telling you why? What diagnosis are you using for the E/M visit? Is it different?

      I know I am asking more questions but this seams very odd and interesting. –Manny

  23. Polly says:

    Hey Manny,
    Quick question about the flu shots. Do you know if Medicare and the commercial insurance companies are requiring the NDC on all claims? I have been trying to research it but I am not able to find anything. I know you said Tricare does require it but I was wondering about everyone else. Thanks for your help!!!!

    • Yes Tricare does require NDC numbers. I am not sure if Medicare or commercial insurance companies require the NDC. I never looked into it. The reason it does not matter is since we had to include the NDC for Tricare in our computer system the NDC is now automatically picked up and sent with the other vaccine data to all the carriers.

      Polly I am not sure if I am answering your question but once you include the NDC in the code tables of your practice management system everyone gets it. –Manny

  24. Sheila Hale says:

    I am looking for some tips on billing for a Pediatric office. For comm'l carrier and of course BCBS Healthchoice/Medicaid. well child visits and etc.

  25. mary says:

    if we do bill a 99213 along with 90658 and the 90471 will the insurance pay us less money on the office visit. i have been billing just the flu and the office code without the administration because sometimes insurances will decrease the payment considering it part of another procedure. what is your opinion on this

    • Hi Mary, typically we when we bill out an office visit 99213 with the flu vaccine 90658 and the admin 90471 our reimbursement rate for any of the services is not reduced. The multiple procedures rule does not usually apply to a vaccination. Have you checked your fee schedule with specific payers? What have the insurance representatives told you when you have called to follow up on this payment discrepancy? Please send us more information and we can try to point you in the right direction. Based on our experience, we have not had problems getting the proper (not reduced) reimbursement when billing out these 3 CPT codes together.

  26. John K says:

    If my office wants to do a sort of flu express to administer the vaccination without having patients need to pay a copay, what diagnosis, procedure and encouter codes do use?

    • John sounds like you are going to have a flu clinic where you see a lot of patients at one time. We once had 400 patients come through in 2 hours at a flu clinic we held at our medical office. I worked for The Walt Disney Company in the past and know about crowd control and how to get people though a line fast. It worked well and the wait was only a couple of minutes.

      For your clinic you still would bill these flu shots just as you would normally. Use 90471 (Immunization Administration) and 90657 (Influenza vaccine for children 6-35 months) or 90658 (Influenza vaccine for individuals 3 years or older) as appropriate for the patient’s age. For Medicare use G0008 for the administration code and the correct G code for the vaccine which is dependent on the manufacture (See above for codes). The V04.81 diagnosis typically goes with the flu shot.

      Most insurance company no longer reimburse for a 99201 or 99211 so if they are just coming in for the flu shot you really don’t need to bill for the encounter. These encounter codes are the codes that usually cause the patient to have a copay. Billing just for the admin and vaccine should not cause the patient to have a copay. That has been our experience with our pediatric practice.

      As always you should check with your insurance carriers for their specific billing, reimbursement and documentation rules.

  27. Shane Parker says:

    Can we bill Office visit along with flu shot?

    • Are you asking about billing a “nurse visit” 99201 or 99211 with your flu shot? If so, most insurance companies stopped paying those codes with vaccines. If the patient is coming in for an unrelated problem such as for a rash for example, you are able to bill a higher level office visit code with the appropriate diagnosis for that problem and then bill the flu vaccine and admin code with a V04.81. Check with your insurance carriers on their specific rules.

  28. Stephanie T says:

    Hello. I am getting ready to do roster billing for our flu shots this year. I found the Q code that we need to use and the fee schedule for that. I am having trouble finding the Indiana injection fee schedule. Can you tell me where to find that?
    Thanks!
    Stephanie

    • The best place to start is the CMS website.

      https://www.cms.gov/apps/physician-fee-schedule/o

      Through the website you can then narrow your search parameters to look for your Specific Locality or Specific Carrier/MAC. Just enter in the codes you are looking for in the HCPCS Code Box and search and this should bring up the requested information. Otherwise, depending on your local Medicare Administrative Contractor (MAC), go directly to their website and they should also have an available fee schedule for you search.

  29. Mirna Ingles says:

    Good morning Manny, I have a question I've been submitting flu shots to tricare and they have been rejecting because they want the national drug code, then sent them back with NDC but according to them thats not the correct one. Do you know what NDC would I use to bill for it? I also checked the websit cdc.gov could not find anything,

    Help! thanks Mirna

    • Mirna, take a look at the package insert for the vaccine. The NDC number is specific to the manufacture, vaccine and strength. The proper NDC number for your vaccine should be on that insert. Use that number for your claim. One additional item to remember is that there is a specific format that you must follow when you put NDC numbers into your computer system. NDCs are in a 11-digit format and are usually seen in a 5-4-2 format. For example: 99999-9999-99. Sometimes on the package insert they are in 10-digit formats. Before entering the number into your computer system you must convert it to an 11-digit NDC or your claim will be denied.

      Use the following methodology to convert your NDCs from 10-digits to 11-digits:

      If 10-digit NDC format is: 4-4-2 9999-9999-99
      Then add a zero (0) in: 1st position 09999-9999-99
      Report NDC as: 09999999999

      If 10-digit NDC format is: 5-3-2 99999-999-99
      Then add a zero (0) in: 6th position 99999-0999-99
      Report NDC as: 99999099999

      If 10-digit NDC format is: 5-4-1 99999-9999-9
      Then add a zero (0) in: 10th position 99999-9999-09
      Report NDC as: 99999999909

      Hope this helps. If it does, give me a +1 and a LIKE to let me, and others, know this was helpful. The buttons are on the top of the post. Thank you.

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