CPT Code Changes Narrow Gap Between Reimbursements for Combination Vaccines, Individual Vaccines

A new study shows that previous CPT coding paid physicians less for giving combination vaccines than for giving individual vaccines, supporting the change to new immunization administration codes earlier this year, according to a Medscape report.

The study, commissioned by HHS' National Vaccine Program Office, was published online on Nov. 22 in Pediatrics and showed that between June 2007 and July 2009, physicians earned less for administering combination vaccines than for administering equivalent component vaccines, because they received fewer immunization administration payments.

The CDC has recommended combination vaccines since 1999 as a method of decreasing the number of injections children must receive. Providers voiced concerns that they were incentivized to administer more vaccines because reimbursement was significantly higher for multiple single vaccines than for one combination vaccine.

Compared to the codes used in the study, new CPT codes offer improved reimbursement for combination vaccines. Despite these changes, however, the difference in reimbursement still exists. For example, if payers were to use the 2011 Medicare Resource-Based Relative Value Scale physician fee schedule for the new IA codes, physicians would receive reimbursement of $46.20 for the administration of Pediarix as a combination vaccine and $69.30 for administering the three components individually.

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