MSP Billing: How to Bill for Immunizations and Injections

In British Columbia, billing immunizations and injections for MSP billing can be quite complicated as there are different requirements for patients depending on their age. We are finding that many physicians are billing these codes incorrectly and are spending a lot of time fixing errors or missing out on revenue potential. In this blog, we will share a breakdown of the latest updates to immunization and injection codes and provide examples to help you reduce billing errors and rejections.

Immunization Fee Codes for Patients 18 Years of Age and Younger

Infants and Children Immunizations

The following chart outlines the timing and billing codes for immunizations and injections for children in British Columbia between the ages 0 and 4 years. All fee codes are valued at $5.43.

Fee Code Vaccine 2 Months 4 Months 6 Months 12 Months 18 Months Starting at 4 years
10027 DTap-HB-IPV-Hib X X X      
10023 Pneumococcal Conjugate X   X   X    
10029 Rotavirus X X        
10020 Meningococcal C Conjugate X     X    
10022 MMR       X    
10026 Varicella       X    
10027 DTaP-IPV-Hib         X  
10010 Tdap-IPV           X
10030 MMRV           X
10015 Influenza     X X X X
10016 Hepatitis A     X   X  

MSP Billing Requirements

  • Billable in addition to an office visit
  • Bill the vaccine code with the ICD-9 code 33A
  • Billable up to 4 vaccinations per patient per day in addition to the office visit

 

Let’s look at an example:

A 6-month-old baby girl visits your office for her vaccinations. What should you be billing? You should bill the code 12100 for the office visit in addition to the immunization codes she is getting. The chart below breaks it down:

Fee Code Value
12100 Office Visit
10027 DTap-H8-IPV-Hib
10015 Influenza
10016 Hepatitis A
$34.79
$5.43
$5.43
$5.43
Total $51.08

School Age Immunizations

The following chart lists all vaccines that are provided to children in British Columbia who are in grades 6 and 9. All fee codes are valued at $5.43.

Fee Code Vaccine Grade 6 Grade 9
10017 Hepatitis B 2 doses  
10028 HPV 2 doses  
10026 Varicella 1 or 2 doses  
10021 Meningococcal Quadrivalent Conjugate   1 dose  
10014 Tdap   1 dose

MSP Billing Requirements

  • Billable in addition to an office visit
  • Bill the vaccine code with ICD-9 code 33A
  • Up to 4 vaccinations are billable per patient per day in addition to the office visit

 

Here is an example:

A boy in grade 9 comes into your office for their vaccinations. As with the children and infants immunizations, you should bill the code for the office visit (in this case, 00100) in addition to the codes for the immunizations he is getting. The chart below breaks it down:

Fee Code Value
00100 Office Visit
10021 Meningococcal Quadrivalent Conjugate
10014 Tdap
$31.62
$5.43  
$5.43
Total $42.48

Immunization Fee Codes for Patients 19 Years of Age and Older

The following chart lists all vaccines available to patients 19 years of age or older who were not immunized in childhood. It also lists the recommended vaccines for those who are in high-risk groups, such as those with chronic illness or weakened immune systems.

Vaccine 1st visit 4 weeks later 2 months after 1st visit 6 months after 1st visit 6 months after 2nd visit Every 10 years
Meningococcal C Conjugate X          
Meningococcal Quadrivalent Conjugate X          
Tdap X          
MMR X X        
Hepatitis B X X   X    
HPV X   X X    
Varicella X   X      
Td   X     X X
Influenza X X X X X X
Pneumococcal Polysaccharide X X X X X X

For these patients  there are two codes that you can use to bill for immunizations and injections. For intramuscular injections use fee code 00010 and for subcutaneous injections use fee code 00034. Please note that you will only bill these codes If the sole purpose of the visit is the injection.

Fee Code Description Value
00010 Injection, Intramuscular   Intramuscular (IM) injection includes influenza (flu) shot and other IM immunizations for patients 19 years or older $11.37
00034 Injection, subcutaneous   Subcutaneous injections including desensitization treatments, immunization, oral polio vaccine, etc. (maximum charge per sitting – 3) $11.37

MSP Billing Requirements

  • Codes apply to all MSP funded vaccinations as well as other injections such as vitamin B12 testosterone and allergy shots
  • Bill the vaccine code with ICD-9 code 33A
  • A maximum of three of any combination of 00010 and 00034 are billable per patient per day
  • Fee code 00010 and 00034 are not billable with a visit fee for the same patient on the same day

 

Here is an example:

A 40-year-old man comes in to get his allergy shot. How much would you bill?

Fee Code Value
00010 Injection, Intramuscular $11.37
Total $11.37

In this example, you only bill the 00010 fee code for $11.37 because the sole purpose of the man’s visit was to get his allergy shot. In the case where he may have come in for another reason and decided to get the shot as well, you would only bill for the office visit (fee code 00100).

Temporary MSP Billing Fee Codes for Immunization

During the COVID-19 pandemic, the Ministry added the following four temporary fee codes to incentivize respiratory vaccines.

Fee Codes Description Value
T10042 COVID-19 immunization (with visit) $5.43
TB10043 COVID-19 immunization (without visit) $14
TB10044 Extended COVID-19 Immunization (extra) $17.62
T10045 COVID-19 immunization advice fee (extra) $17.62

Please note that all COVID-19 fee codes are required to be billed with the diagnostic code C19.

For more information on how to bill COVID-19 immunization codes, read our blog on Understanding MSP Billing Codes for COVID-19, Virtual Care and Telehealth here.

Have questions on how to bill the MSP billing codes for immunizations and injections? Contact us today! We’re happy to help.

 

Subscribe to our Newsletter

Sign up for periodic emails on company news, blogs, events, product news, and marketing offers. We respect your inbox and you can unsubscribe at any time.